Best practices to heal dog bites

Dogs are known as our furry best friends. Yet, all dogs come with the risk of biting. The 2022 ASPS Procedural Statistics Release showed almost 19,000 people had reconstruction procedures for dog bites last year.

Any dog can bite if provoked. The American Veterinary Medical Association said it's not a dog's breed that determines if it will bite, but it's individual history and behavior. Half of dog bites come from household pets.

"The classic thing that happens is a patient comes in and the parents say, 'This is a loving pet. They've never done this and we've had them forever,'" said Morgan Martin, MD, a board-certified plastic surgeon in Cullman, Ala.

Dr. Martin has made several posts on social media about children in her area dying from or being injured by dog bites.

"In the span of one week we've had two deaths of children," said Dr. Martin. "The first being a four-year-old, the second being a two-year-old. Not just bites, but deaths. That's why I made those posts because I was trying to educate everyone about the potential risk."

Greater risk for young children

Young children are often more at risk of being bitten because of their short stature, relatively large head size, underdeveloped motor skills and lack of understanding of or fear of dogs. The nose, lips and ears are often the most injured areas in children because dogs can grab onto them.

"Children tend to have more head and neck injuries because they're face-to-face with the dog, whereas adults tend to have more hand and leg related injuries," said Kaveh Alizadeh, MD, MSc, FACS, a board-certified plastic surgeon in New York.

Dr. Martin added children often are not familiar with the warning signs dogs give before biting.

"When a dog is threatened, they may lay their ears back and have a certain posture," said Dr. Martin. "A child is less likely to recognize those signals and be able to quickly get out of the way, versus an adult. There may also be no warning signs. Dogs can also attack without being provoked."

Proper treatment

Treating dog bites immediately and correctly leads to better aesthetic and functional outcomes. It's important that children see pediatric face and hand specialists early to get the best long-term results since they are still growing.

Dr. Alizadeh helped develop a process for doctors on how to treat different types of dog bites for the best outcomes. First, he said always to seek an informed medical opinion. He has seen many people turn first to social media, where they get inaccurate advice.

"I have seen patients who put toothpaste on a dog bite because that's what they saw on Instagram," said Dr. Alizadeh. "The internet is the go-to source for information as opposed to doctors."

Dr. Alizadeh recommends immediately seeing a medical professional after being bitten, even if the bite isn't severe. He suggested people go to a family physician or pediatrician, urgent care or an emergency room.

"Your best chance at a successful outcome is that initial treatment because it needs an expert to say, 'This is the pathway we're going' as opposed to, 'Oh, just put a Band-Aid on it don't worry about it,'" said Dr. Alizadeh.

The wound needs to be properly washed to stop the bacteria from the dog's mouth from causing an infection. A rabies shot might also be needed if the dog's vaccination status can't be determined.

Always bring any body parts that might have been torn off, including chunks of skin, to the medical facility. Reattaching them will lead to a better aesthetic outcome.

"It's extremely hard to replicate specialized tissue like the ear, the nose, the lips," said Dr. Alizadeh. "It's much easier to put these back on as opposed to doing other surgeries to be able to reconstruct them."

Also, take as many videos and pictures as possible of the injury, the dog and the setting.

"It's important to have all the documentation both for a medical and legal standpoint," said Dr. Alizadeh.

Then get an opinion from a board-certified plastic surgeon who is an ASPS member if one is not on staff at the medical facility once the injury is initially addressed.

"Share the photos with an expert plastic surgeon," said Dr. Alizadeh. "Ask for a second opinion because in that initial treatment, if the injury is not put together well, you're going to have problems."

Healing hands

Injuries to the hand often happen because a child is holding something a dog wants such as food or a toy.

Amber Leis, MD, a board-certificated plastic and hand surgeon in Orange, Calif., restores both the look and function of hands after a bite. She uses powerful magnifying eyeglasses and microscopes to reconstruct small blood vessels, bones, nerves, joints and tendons in the hand. Surgery is essential, but hand therapy is also critical to keep the hand flexible.

"Hands can have so much swelling and then the swelling itself creates pain and stiffness," said Dr. Leis. "We really work closely with our hand therapists to keep everything moving, keep the scars healing, keep everything softening the way we want."

Hand scars also tend the heal well. Dr. Leis said one to two years after surgery it can be hard to see them.

Addressing trauma

Trauma can also be a factor in dog bite cases. Families are often distraught because many bites come from a beloved family pet.

"They're devastated by what's happened," said Dr. Leis. "This is their child and their pet, two creatures they are responsible for and love very much. They feel like they've betrayed both of them. I think the first thing is to create an environment where the family doesn't feel like I'm blaming them or that it's their fault."

Then there's the trauma long after the bite when someone needs to explain a facial difference.

"The first thing another child is going to say is, 'What happened to your face?'" said Dr. Alizadeh. "You have to go back and relive that story over and over again. It doesn't allow you to move on. This could be something someone is embarrassed about or proud to get through. It's two different pathways."

Dr. Martin said it's important to get a pediatrician involved to monitor the child's mental health and direct them to other resources, if necessary.

According to Dr. Alizadeh, it's critical the patient and family understand upfront some injuries will require more than one treatment.

"I tell them I'm going to do my best to put everything back together," said Dr. Alizadeh. "Then you heal. Based on that, we may have to do a bunch of interventions. I can't promise you it's going to be only one operation. We may have to do further ones down the line."

Scar revision can also be an option, if necessary, usually a year after surgery.

Ultimately, it's best to avoid dog bites in the first place, if possible. That means teaching children early how to treat pets and not to approach strange dogs. It's important that even young children understand they should not touch a dog's food or toys. It also means dog owners need to take extra care to make sure pets are contained or on a leash.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.