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Dog Bite Wounds - The tip of the iceberg

Posted in Operations @ Mar 23rd 2017 - By Dr Gerardo Poli, Director Animal Emergency Services
Bite Wound Entering The Chest 640x480

Dog bite wounds are one of the most common presentations both in general and emergency practice, and they can often be challenging cases.

Once you have stabilised the patient, it is time to go speak to the client. Here is the most important point that you need address:

The injuries you see are just the “Tip of the Iceberg’’.

It can be helpful to draw pictures to let them know that a small penetrative puncture wound can often be masking a horrific injury underneath, especially in big dog on small dog bite wounds, where the small dog is often picked up and shaken around.

The image above is a great example of the need to explore deeper. It shows a single penetrating dog bite wound, however when explored it had entered the thoracic cavity and had torn the diaphragm.

Here are some of my tips when managing a dog bite injury.

Get the nurse to do a very large margin of clipping. When it doubt, clip A LOT more than you think you’d need to.

Explore all wounds to their depths by dissecting the tissues until you are satisfied it does not lead any deeper or further.

‘The solution to pollution is dilution’. Lavage as much as you can and remove all visible foreign material.

Peri-operative antibiotics are always indicated.

Drains: Try to reduce dead space with tacking sutures or closing down the wound in layers. If unable to do so completely, drains may be used. Remember, the drain should exit next to the wound, not through it.

Pain control is very important for these patients. Poor pain control will affect healing and therefore overall outcome. Often multimodal pain control strategies are required, for example a combined opioid and non-steroidal anti-inflammatory strategy.

Make sure you take proper photos before, during and after surgery, especially in cases where your patient’s owners might seek compensation from the owners of the aggressor dog

Any questions for Gerardo? Ask them in the Comments section below.

This post originally appeared on Dr Poli's Blog on the 'miniVET guide Companion Animal Medicine' website and has been reproduced with full permission.

About Gerardo

Dr Gerardo Poli is an emergency and critical care veterinarian and company Director at Animal Emergency Services.  He has a strong focus in the triage, stabilisation and management of critically ill patients, small animal ultrasound and radiology and emergency surgery.

He is the author of The Mini Vet Guide To Companion Animal Medicine; a pocket sized, quick-reference guide designed to help veterinary students through their final years of vet school and also for recently graduated veterinarian making the transition into vet clinical practice. 

Find out more about The MiniVet Guide to Companion Animal Medicine by visitng the website: www.minivetguide.com

Or visit the Facebook Page: www.facebook.com/DrGerardoPoli

You can also find out more about the Animal Emergency Service in Brisbane here: www.animalemergencyservice.com.au

 

Comments

Antony Karolis @ Apr 24th 2017 8:29am
Hi Gerardo, One of the things I frequently mention to vets less experienced with treating bite wounds is the need to allow the wound(s) to mature after the initial clean and stabilization. I often see neatly sutured bite wounds fall apart a couple of days post-op due to unidentified necrotic tissue being left in the wound. I generally clean the wounds under GA, dress them, and perform a second procedure 48 hours later. Is this appropriate or should I be seeking to finalise surgery during the first surgical procedure? Thanks
Gerardo Poli @ Apr 27th 2017 2:09am
Hi Antony, there is definitely a time and place for that two stage strategy. We use it often for severe wounds, dirty wounds, wounds involving bones/ joints. It is not uncommon for parts of a wound to become devitalised due to trauma to its blood supply or we need to allow for drainage or granulation to occur before final surgical repair. I would say that the majority of the time, if the wound is lavaged and debrided back to healthy bleeding tissue it can be primarily the first time. I always explain that tissues may die back and wounds may need a second surgery if the wound opens up but I generally try to repair it the first time to save the requirement for a second surgery. As clinicians we are guided by our personal experiences and there is no fault in your practice.

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