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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 shook around.
This image 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 tore 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 ALOT more than you think you’d need to.
- Explore all wounds to the 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.