Life-Threatening Panfacial Wild Dog Bites in a Child

Abstract

Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be lifethreatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissuehandling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.

Surgical Management of Animal and Human Maxillofacial Bites: A Comprehensive Review

“…The items included are from every inhabited continent except Central America. Thirteen studies were from Africa, 13,17,19,20,22,23,[36][37][38][39][40][41][42] 17 from Asia, 32,33,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] 17 from Europe 2,7,11,12,14,15,24,27,28,34,35,[58][59][60][61][62][63] , 14 from North America, 4,10,16,18,25,…”

“…44,71 Some articles have proposed a classification of maxillofacial injuries 2,14,19 but Lackmann´s classification (Table 1) 76 has been used most frequently in articles to describe this type of injury. 28,34,54 A description of maxillofacial injuries such as puncture, laceration and abrasion were found in most articles. Puncture wounds are more susceptible to infection than large lacerations.…”

“…Ensuring an adequate blood supply to soft tissues is the cornerstone of preventing necrosis and reducing wound infection. 54,70 The central region must be handled first because of a more complicated surgical management. 7,14,47,54,66 Facial wounds that are not sutured can result in severe unaesthetic and functional damage.…”

“…54,70 The central region must be handled first because of a more complicated surgical management. 7,14,47,54,66 Facial wounds that are not sutured can result in severe unaesthetic and functional damage. 9,18,35,41,51,54,70,72 Spaces between stitches on the skin can be useful to enable for spontaneous drainage, 72 a suitable option for scar reduction.…”

“…7,14,47,54,66 Facial wounds that are not sutured can result in severe unaesthetic and functional damage. 9,18,35,41,51,54,70,72 Spaces between stitches on the skin can be useful to enable for spontaneous drainage, 72 a suitable option for scar reduction. Most surgeons suggest delayed primary closure without infection, reducing the rate of infection, or using a dressing.…”