Sometimes the good old times – like scar revisions – keep rolling and rolling. Academic surgery has always been real fun, even more so now without any universities involved, meetings to go to, head of departments to cajole, deans to entertain …
A lot of material is still unpublished, new issues keep accumulating on the back burners. It is a hobby now, but about twice a year we still get round to write things up, most recently the largest single institution series of facial dog bite injuries and scar revisions in children – Eppley BL, Schleich AR, Facial dog bite injuries in children: treatment and outcome assessment. J. Craniofacial Surg. 24(2):384-6, 2013.
Facial Dog Bite Injuries in Children
Dog bites to the face are a relatively common injury in young children, and often require repeated plastic surgery procedures to deal with persistent scarring, according to a report in the March Journal of Craniofacial Surgery.
In the study, Dr. Barry L. Eppley of Indiana University Health North Hospital, Carmel, Indiana, USA and Dr. Arno Rene Schleich of Trinidad Institute of Plastic Surgery, Port-of-Spain, Trinidad, review a ten-year experience of the common dog bites of the face in children, the largest published series of this kind to date. “[R]egardless of the severity of the trauma, most dog bite injuries result in permanent scars, and secondary revision surgery is frequently needed,” the researchers write.
Dog Bites in Children — Patient Characteristics
From 1995 to 2005, Dr. Eppley treated 105 children with dog bits of the face, scalp, and neck. The children’s average age was about six years — the youngest was 6 weeks and the oldest 11.5 years. In contrast to previous studies showing that most dog bites occur in boys, Dr. Eppley’s patients were about equally divided between girls and boys.
In 95 percent of cases, the dog was known to the patient and family — belonging either to the family or to a friend, neighbor, etc. When the breed was known, the most common was Pit Bull, followed by Chow, German Shepherd, and Doberman Pincher. Most of the bites were classified as “provoked,” occurring when the child was playing with, petting, or otherwise interacting with the dog.
In 90 percent of children, the bites caused a combination of crush, laceration, and shear injuries. However, in most cases the wound could simply be closed (ie, with stitches), with no significant risk of infection. Some bites required skin grafting or other reconstructive surgery. One child developed an infection and one was left with permanent injury to the facial nerve.
High Rate of ‘Scar Revision’ Surgery
In more than three-fourths of cases, the child underwent additional “scar revision” surgery in an attempt to improve the aesthetic results. About one-fourth of patients needed a second or even third revision surgery.
More than one-third of cases involved legal action, either against the dog’s owner or insurance companies. Because of the high litigation rate and possible denial of insurance claims for reconstructive procedures, Drs Eppley and Schleich advise surgeons to keep meticulous records, including photographs, of dog bite cases.
Dog bites are a common in children, with many of these injuries involving the head and neck. The new study highlights the characteristics of facial dog bites in children, including the young age of the patients and the fact that most bites are “provoked.” The researchers strongly suggest that young children be kept away from “high-risk” breeds.
“Even with favorable results from scar revisions, the patient and family may still regard the scars as a permanent disfigurement,” Drs. Eppley and Schleich write. They suggest that plastic and craniofacial surgeons treating dog bite injuries in children should advise parents about the possible need for further surgery for scar revision, and provide counseling to “align expectations with expected surgical outcomes.”
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