Facial dog bites in children may require repeated plastic surgery

'Revision' procedures often needed to manage scars, reports study in Journal of Craniofacial Surgery

2013-04-22

(Press-News.org) Philadelphia, Pa. (April 22, 2013) - 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, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In the study, Dr. Barry L. Eppley of Indiana University Health North Hospital, Carmel, and Dr. Arno Rene Schelich of Hans Privatklinikum, Graz, Austria, review a ten-year experience of the common dog bites of the face in children. "[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 Pinscher. 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."

### About The Journal of Craniofacial Surgery Journal of Craniofacial Surgery, edited by Mutaz B. Habal, MD, FRCSC, serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

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Facial dog bites in children may require repeated plastic surgery

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