What to Know about a Dog Bite Wound

With over 4.5 million occurrences annually, dog bites are a prevalent and often severe issue that demands meticulous wound care management. Even experienced wound care specialists can be challenged by the varying severity of cases, from those that are mild and can be managed at home to those requiring stitches, emergent surgical intervention, and/or antibiotic treatment. 

Given the potential dangers of a dog bite wound, it is crucial for practitioners to respond quickly and appropriately to ensure the best outcomes. However, the exact course of action is not always clear. When should prophylactic antibiotics be used? Does treatment vary based on injury location? What patient and wound factors might increase the risk of infection? These are the questions that need to be addressed promptly. 

Here, we aim to provide a comprehensive understanding of how to treat dog bite wounds, how these animal bites differ from other wounds, and the key information that providers should be aware of. Let’s dig in and look at how to effectively manage dog bite injuries.  

The Most Common Type of Animal Bite: Dog Bite Wounds

Dogs are said to be “man’s best friend” because of their loyalty, companionship, and playfulness but no matter how cute and endearing one might seem, dogs will bite if they feel threatened. Sometimes, these bites are accidental, such as when individuals wrestle with their dog, but other times, they are a response to feeling startled or stressed. 

Adults are often able to spot behavioral cues that may indicate that a dog might bite, like growling or lunging, when you enter their space. However, many of these signs could easily be missed, especially by children, who are less likely to be aware of the differences between a dog being high-spirited and aggressive. Research even supports this, revealing that most dog bite patients are children bitten by animals they know. 

The Stats on Dog Bites

While animal bites make up 1% of emergency department visits in the United States annually, 95% involve dogs and cats. Dogs alone contribute to over 337,000 emergency visits and produce medical costs of up to $2 billion each year. They’re a weighty burden to our healthcare system and, according to the American Veterinarian Medical Association (AVMA), a public health problem due to the inestimable hidden costs to communities. 

For example, the insurance industry states that it pays over $1 billion annually in homeowners’ liability claims as a result of dog bites. Then, there are lost wages, business expenses associated with sick leave, workers’ compensation claims, medical insurance claims, and more that haven’t been calculated.

Plus, dog bites are high-risk, partially because of who they affect most. We mentioned that kids are the majority of dog bite victims, but did you know that half of them are under the age of 12? In addition, children often experience dog bites on the neck and head, which are life-threatening locations, while teens and adults usually present with bites to the arms and hands. Individuals over 70 years of age, who are also more vulnerable, make up 10% of those bitten by dogs and 20% of those killed by them. 

How Do Dog Bite Wounds Differ from Other Wounds?

If someone presents to the emergency room with a wound caused by a sharp object, such as a kitchen knife, there are probably fewer variables to consider. The laceration is probably a clean cut in a straight line and affects one localized area. However, dog bites differ in a few ways. 

Dog Bites Can Create Complex and Costly Injuries 

Wound from animal bites, and dogs in particular, can be far more complicated than other causes of wounds. For one, dogs grab with their teeth, hold with their jaw, and shake their heads when they bite. This action can tear skin, crush bones, and impair nerve and muscle function, which isn’t always visible externally. The underlying skin could be torn and interfere with supporting blood supply even when the superficial skin is intact. Research shows that these features can cause an extended inflammatory phase of healing compared to other wounds, boosting the risk of pathological scarring. 

Some incidents result in a combination of wounds that require plastic surgery and long-term medical intervention to repair. 

They Have a Greater Risk of Infection

Dog bite wounds are also highly contaminated. Multiple types of microorganisms from the environment, the victim’s skin, and the dog’s mouth are involved. Because of this, some practitioners are unsure whether to perform a primary closure or closure by secondary intention. 

There’s concern that suturing the wound too soon could cause bacteria to remain trapped under the skin. However, some studies have shown that primary closure with different types of wound contamination has not increased the infection rate compared to healing by secondary closure. Closure by primary intention is also said to create more aesthetically appealing outcomes. 

Dogs Could Have Rabies

The viral disease rabies isn’t as common in domesticated animals, but the risk of acquiring this potentially fatal condition is possible if bitten by a dog. Practitioners should keep in mind that just 45% of dogs that cause bites resulting in an emergency department visit have been vaccinated for rabies. 

Each year, approximately 16,000 to 40,000 individuals in the United States receive postexposure prophylaxis if they’ve been potentially exposed to a rabid animal. This treatment is 100% effective when used correctly but costs nearly $1,000 to receive.

Dog Bites Even Differ from Other Animal Bites

All animal bites are the same, right? Well, not exactly. Cat bites, for instance, primarily cause deep and narrow puncture-type wounds, as cats typically just bite and hold. Dog bites may involve tearing forces and are more likely to cause skin maceration, where the skin softens and breaks down due to extended exposure to moisture. 

The Different Types of Dog Bite Injuries 

Just like all animal bites aren’t the same, neither are dog bites. There are different types, and one dog bite alone can lead to a combination of types of wounds. Crushing Dog Bite Wound

Some dog bites create a crushing wound due to their rounded teeth and strong jaws. The powerful force and pressure, especially from a large dog, can lead to nerve damage, internal bleeding, bone fractures, and more.

Dog Bite Avulsion Wound

Avulsion injuries can also occur from being bitten by a dog. Here, the tissue is torn away, causing the muscle or skin to hang off the body. These wounds are serious and often result in patients experiencing dangerous blood loss. 

Laceration Wound 

A dog bite that causes a deep cut in the skin and travels past the epidermis and into the nerves, bones, muscles, and blood vessels of the body is a laceration. These most commonly happen on the face and require stitches. 

Dog Bite Puncture Wound 

When dogs bite down, their teeth pierce through the top layer of skin, causing a puncture wound. Because these usually look small and less concerning, many patients won’t visit a medical professional unless they notice signs of an infection. These wounds could be very deep and may seal quickly, trapping bacteria in an oxygen-free environment where they can thrive and spread. For those reasons, many practitioners find treating a puncture wound from a dog bite complicated. 

Abrasion Dog Bite Wound 

Dog bites aren’t always severe. In fact, some abrasion injuries caused by dogs don’t require any medical intervention and can be treated by the patient with basic first aid. For example, a superficial injury, like a scrape or graze that doesn’t extend beyond a patient’s epidermis, can just be monitored for infections or complications. Practitioners might not have to step in unless the abrasion is sizable, deep, infected, or on a sensitive body part (e.g., neck or genitals). 

Treating a Dog Bite Wound 

This might be shocking, but today, the evidence for dog bite wound care still isn’t strong enough to standardize care. As a medical professional who ideally wants to follow recommended best practices, this lack of standardization can make doing your job more challenging. But because dog bite injuries are complex, have differing levels of severity, and have varying clinical experiences, it’s hard to establish a consensus on how to best manage them. Nevertheless, there are some protocols to guide you along. 

1. Perform History and Physical Examination

Anytime a patient presents with a bite wound, reviewing their medical history is crucial, as this information can guide you on what steps to take next. You’ll want to determine if the patient has any immunocompromising factors that may increase their risk of infection and/or complications. For example, conditions like diabetes and rheumatoid arthritis or a patient struggling with substance abuse or malnutrition can interfere with treatment effectiveness. 

Determine if the patient has received vaccinations for tetanus, diphtheria, and pertussis, then take the appropriate action. 

For more severe wounds, before performing the physical exam, it’s essential to provide pain management to maximize patient comfort and compliance. After initiating local or general anesthesia, and the patient is stable, look for damage to underlying structures, such as tendons, nerves, bones, and joints. You should also carefully assess the wound for foreign bodies, like plant material, dirt, and broken canine teeth. 

In addition to the above, be sure to note if the patient: 

• Is feverish 
• Has local erythema 
• Purulent drainage
• Swelling and warmth at the wound site

2. Reduce the Risk of Infection

Regardless of the type of dog bite wound, practitioners should treat the injury as contaminated and take steps to minimize infection. Clean the skin surface area and irrigate the wound with water and saline solution. If the animal is rabid, povidone-iodine solution should be used instead. 

The American Academy of Family Physicians (AAFP) states that a 20-milliliter (mL) or larger syringe should be used to create the high pressure needed for proper cleaning. This high-pressure irrigation is especially important if you’ll be performing healing by primary intention. Careful debridement following irrigation can further minimize the risk of infection. 

Although this 2007 study is a bit dated, researchers share that the strongest predictor of infection development is being a woman, wound depth, and needing surgical debridement.

When to Administer Antibiotics

Current research suggests that if the wound is closed via primary intention, practitioners should discharge the patient with a prescription for a week of amoxicillin-clavulanate. 

Oral antibiotics should also be given if the patient has crush injuries, puncture wounds, vascular damage, or is bitten near a joint or on the face or genitals. This protocol is suggested regardless of whether the patient shows signs of infection. 

If you do notice signs of an infection, it might make more sense to administer the antibiotics intravenously. This approach delivers the medication directly into the bloodstream, where it can reach tissues faster. 

The type of antibiotics given, as well as the timing, dosage, and route of administration, may depend on the pathogen the patient is exposed to. In most cases, antibiotics are not required for clean, superficial wounds. 

3. Wound Management

How you manage a dog bite largely depends on where the injury is located and when the patient seeks treatment. Try to determine the wound’s risk level, which is mainly based on the probability of infection, as well as the following factors: 

• The patient’s health status
• Dog breed, as Alsatian mixes, pit bulls, rottweilers, German Shepherds, shih tzus, and Dobermans are breeds more likely to be associated with causing dog bites
• Wound depth
• Amount of tissue destruction 
• Joint involvement 
• Bite location

Primary Closure vs Secondary Intention

Evidence suggests that most dog bite wounds should heal by secondary intention unless the bite occurred in a high-risk location. 

Turnaround Time from Initial Bite Injury to Medical Appointment

The time the initial dog bite wound occurs and the timeframe in which the patient seeks treatment also plays a significant role. Patients who delay treatment one to two days are 3.5 to 7 times more likely to require hospitalization or surgery, respectively, than those who seek medical attention the same day. 

Practitioners should also keep in mind that the risks of closing the wound almost always outweigh the cosmetic benefits of closure when treatment is delayed. Delays increase the risk of infection. Therefore, injuries with a higher risk level should be closed by secondary intention, even though primary closure has better cosmetic outcomes. It’s ideal to administer antibiotic prophylaxis even if there are no signs of infection when medical consultation is delayed. 

When Referrals Should Be Suggested

There are times when a case will require specialty care that goes beyond your practice level. Advanced care may be necessary in the following scenarios: 

• A patient has severe cellulitis
• There are signs of systemic infection 
• It appears the bite requires reconstructive surgery, which is more likely for hand bites, as the hand has many small structures that must be managed carefully
• Tendons, joints, or bones have been affected 
• Bites to infants and children 
• Facial or cranial bites 

The Best Treatment for a Dog Bite Wound

Ideally, it’s best to prevent dog bites altogether through better education and behavior changes (both for you and the dog where possible), but as we know, that isn’t always feasible. So, the next best thing health professionals can do is provide high-quality treatment to patients if such an event does occur. By being knowledgeable of the latest guidelines and treatment protocols, we can increase the likelihood of excellent patient outcomes.