Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 8 , ISSUE 1 ( January-April, 2019 ) > List of Articles

CASE REPORT

Primary Closure of a Complex Facial Wound with Underlying Fractures. Deconstructing Dogmas

Saptarshi Biswas

Keywords : Dog bite, Maxillofacial fractures, Soft tissue injury

Citation Information : Biswas S. Primary Closure of a Complex Facial Wound with Underlying Fractures. Deconstructing Dogmas. Panam J Trauma Crit Care Emerg Surg 2019; 8 (1):64-69.

DOI: 10.5005/jp-journals-10030-1239

License: CC BY-NC 4.0

Published Online: 01-04-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Canine bites present a major public health concern worldwide. Facial fractures due to dog bites are rare, although the exact incidence is unknown. Most reports in the literature comprises of pediatric population with a majority of the patients less than 5 years of age. Zygomatic, nasal, and orbital are the most frequently fractured bones. The dog breeds commonly responsible are American Pittbull and Rottweiler. The injuries can present as punctures, abrasions, tears, or avulsions. The intense kinematics of the crush injury can result in devitalized tissue, thus management becomes complex. Primary repair of these complex facial wounds can provide good cosmetic results. Controversy remains whether dog bites should be closed primarily and the indication for prophylactic antibiotics. Complex facial injuries cause functional and cosmetic impairment together with potential polymicrobial infections. They can also leave behind emotional scarring that can last long after the wound has healed. Antibiotics are indicated for infected bite wounds only and those of complex nature involving underlying bones, vascular structures, or joints. Tetanus immunization and potential risk of rabies should be considered in these patients.


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