Dog Bites: Prevention and Treatment

San Diego Plastic Surgeon Hand Specialist

Last week, I treated a young woman who works at a dog boarding and training facility. She had just clocked out for the day when she heard a dog fight break out. While trying to break up the dogs, she got a large chunk of her left thumb tore off, the thumb nail and bone under it were gone.

In the ER, they put a stitch in, dressed it, and told her to see a San Diego plastic surgeon hand specialist. I was able to fit her in the next afternoon after our full schedule. The dog bite was a complicated amputation with exposed bone and near the joint (important for full hand function). She thought there was no way she could get her thumb fixed by a plastic surgeon on a Friday afternoon. You should have seen how happy she was when I told her that we would get it done ASAP.

I spent the next 1 ½ hours harvesting a full thickness skin graft from the left groin, closing the wound like a fine line with all absorbable sutures. I removed unhealthy tendons, germinative nail matrix, and damaged bone. With the wound clean, I sutured the full thickness skin graft over a flap of subcutaneous tissue covering the bone. I covered the graft with a special Bolster dressing to help the graft “take.” I then dressed the left thumb and left groin.

Mission accomplished!

Check out the video of the whole procedure on Youtube.

Other Dog Bite Experiences

Sadly, one of the worst dog bite patients I’ve treated was a veterinarian. She was walking with her 2 small children when a pack of pit bulls attacked. She sheltered her children while the dogs bit her all over. Thank god her children were saved by the brave mother. I spent over 4 hours in the OR excising chewed up wounds, and closing them like fine, thin lines to reduce scarring. She healed her skin well, but had to quit being a veterinarian due to her fear of animals.

In the past, I have reconstructed a lip missing a large piece from a dog bite. On rare occasions, I’ve borrowed 25% of the opposite lip tissue to reconstruct a large gap in the lip, leaving the lips sutured to each other for 3 weeks! Those patients are my heroes.

The most extensive dog bites are when the police let their K-9s attack a suspected criminal. Those dogs bite deep and can do a lot of damage to the arms and legs. These tricky wounds are high risk for infection when sutured closed. Some require flaps to close, or skin grafts.

What are some lessons to be learned?

  • Never break up a dog fight — your chances of getting attacked are great.
  • Never put your face near a dog muzzle — they don’t instinctively know how to kiss, but they instinctively know how to bite.
  • Don’t resist arrest, especially when the police have their secret K-9 weapon
  • Be careful where you walk, especially in the country where dogs more frequently roam freely.
  • Seek medical attention ASAP. Wound’s are high risk for infection. A dog’s mouth is almost as bad as a human’s mouth for bad bacteria.
  • Ask for a plastic surgeon if available to excise these wounds and repair them with techniques that leave the least conspicuous scars.

From my H-art,

Yale M Kadesky, MD

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