Primary repair of dog bites to the face: 40 cases

Dog bites to the face can be life-threatening if major infection occurs, and traditional management consists of wound toilet and debridement, with repair only when the possibility of infection has been eliminated. Surgical opinion is now swinging towards earlier repair. We have analysed retrospectively the outcome of 40 cases that, irrespective of time delay between injury and presentation, underwent primary repair or reconstruction after wound toilet, debridement and administration of prophylactic antibiotics. The victims were 17 males and 23 females with ages ranging from 2 to 76 years (mean 25). Median delay between the injury and presentation in the emergency department was 60 minutes (range 7 minutes to 5 days). All patients received surgical treatment within 24 hours of admission, 18 being operated on within 6 hours. 31 had primary repairs and 9 patients had reconstructive procedures with local skin flaps or skin grafts. Primary healing was achieved in all but 2 patients, of whom one developed minor wound infection and one had necrosis of a composite graft. These results support the view that, for dog bites to the face, primary repair is the method of choice.