Table 3.

Protocol for management of facial dog bite injuries

Take a detailed medical history and confirm patient's medical fitness.

Document the etiology of the injury along with photographic records.

Bite wounds must be examined carefully for secondary injuries to the facial nerve, blood vessels, tendons, lacrimal or parotid ducts, and bones, as well as ischemia must be ruled out.

Depending on the extent and the location of the injury, the patient should undergo radiological diagnostics (CT/MRI) to make sure no foreign bodies (teeth, food) remain in the wound and to investigate possible bone injuries, particularly relevant for the detection of cranial injuries in a child.

Consider the use of general anesthesia for younger patients to improve the quality of initial care.

Prophylactic antibiotics must be administered where the risk of infection is high and where primary closure is being considered.

Remove visible dirt, perform copious irrigation, culture wounds (if they appear infected), and debride devitalized tissue.

Non-infected facial wounds of less than 24 h duration should be primarily repaired.

Wounds >24 h duration, large crush wounds, puncture wounds, and wounds with devitalized tissue must be observed for 2–3 days, re-evaluated, and managed with delayed primary repair or healing by secondary intention.

Patients should be assessed for tetanus immunization status and treated with immunization or immunoglobulins if necessary.

Rabies vaccination/immunoglobulin administration where indicated.