Emergency treatment for dog bite in the mouth area. A Case report

Abstract

Background: Dog bites are the most prevalent aggression produced by animals, corresponding to 90% of cases. This mainly affects children. The management of these injuries presents a challenge for healthcare facilities to reduce the risk of infection, deformity, and scarring. 

Clinical Presentation: 14-year-old male patient with no morbid history or allergies. He went to the emergency department for a dog bite, with 2 hours of evolution. A deep wound 5 cm long, located in the lower right area of the lip and crossing the midline, was appreciated on physical examination. Perilesional infiltration with 2% lidocaine, profuse cleansing with 250ml of saline solution, suture of the deep plane with 4/0 polyglycolic acid, and the superficial plane with 5/0 nylon. Steri Strip application and antibiotic therapy with amoxicillin / clavulanic acid 875/125 mg. Rabies vaccine and tetanus toxoid booster dose. Referral to the Head and Neck Surgery service. 

Clinical Relevance: Performing primary closure or seeking wound healing by secondary intention remains controversial. Numerous studies have shown similar infection rates when closing lesions compared to wounds left open to heal. The initial evaluation should consider: how the accident occurred, the time elapsed, whether the patient knows the animal's owner, and the pet's vaccination schedule; consider patient comorbidities and tetanus immunization. The management contemplates early profuse irrigation with 0.9% sodium chloride or a povidone-iodine solution, preventing secondary infections, debriding the devitalized tissue, and subsequent optimal closure. Suggested antibiotic therapy is amoxicillin with clavulanic acid. In deep wounds, consider a surgical evaluation and referral to the plastic surgeon. 

Conclusion: Efficient management of dog bites is key to successful treatment. The type of repair should be determined based on the location and extent of the injury. The evidence states that primary closure does not increase the incidence of infection. It is important to collect the animal's vaccination status, the patient's, and at the same time administer prophylaxis against tetanus and rabies if indicated.