Background Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. Methods This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Results Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Conclusions Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.

ver the past 15 years, the use of acellular dermal matrix in breast reconstruction has evolved, with changing trends in implant placement in relation to the pectoralis muscle. From an inferolateral sling in partial subpectoral placement, to full anterior coverage or total wrap with prepectoral implant placement, increasing amounts of acellular dermal matrix are being used in breast reconstruction. 1 Unfortunately, surgical-site infections remain a challenge despite extensive preventative measures adopted by most surgeons. 2,3 Even with optimal proactive management, infection of the implant pocket can still occur and may require implant removal, resulting in reconstructive failure or need for autologous reconstruction. Patient comorbidities that are known to contribute to infection risk include diabetes, smoking, obesity, neoadjuvant chemotherapy, and previous irradiation. [4][5][6] However,