Dog bite or dog eaten!! Our experience in the surgical management of dog bite injuries

Author(s):

Saswati Behera

Background: Dog bite injuries in children are usually grievous and can cause major disability if not addressed on time. In this study, we have summarized our experience on high-grade dog bite injuries in children who required prompt surgical repair after resuscitation. Materials and methods: We retrospectively analyzed the clinical profile of 11 patients of dog bite who were surgically managed in our department during the last 8 months (March 2024-October 2024), including their 6-month follow-up. The characteristics of the victims, the nature of circumstances, the types of dogs encountered and the type and severity of injuries inflicted were studied. Results: The study is ongoing on a population basis in our institution, and over a period of 1 year, dog bite injury necessitated emergency visit in 164 patients where 11 children suffered from severe bites of stray dogs managed with immediate surgical intervention. These were category III exposure as per the national guidelines for Rabies prophylaxis 2019. Hence wound management and administration of Rabies vaccine and immunoglobulins were done as per the protocol. The patients were in the toddler age group (1-3 years) where the youngest child was 18 months old. Majority were males (8 out of 11 children). All the 11 children inflicted major injuries to head and neck region with midface commonly affected with modified Lackmann” s class III A (complete avulsion) and class III B (involving auricular cartilage in 4 children) injuries. Major skin and subcutaneous tissue loss were seen in 3 children who required rotational flaps and split skin grafting for coverage. Underlying bony injuries (shaft of humerus and depressed skull fractures) were found in one child managed by the Orthopedic and neurosurgery teams. The pattern of injuries was quite variable including buttocks (6 children), trunk and limbs (5 out of 11 children). All the children underwent thorough wound lavage, antibiotics prophylaxis and immediate surgical repair. Wounds were healthy leading to satisfactory cosmetic scars on 3 months follow up. Conclusion: Our data shows the typical high-grade dog related injuries in children are caused by unevoked bites of stray dogs during spring and summer seasons. The victims are mostly younger boys who sustain injuries to head and neck region including deep facial avulsions. Timely referral to higher centers for proper wound management and surgical repair can avoid unsightly scars and wound infections.