Comparative study of primary closure versus non-closure of animal bite injuries in head and neck region: case study of 540 patients

Abstract

<p class="abstract"><strong>Background:</strong> Rabies is a zoonotic disease caused by lyssavirus and spread through saliva of rabid animal bite. This study was taken to compare primary closure versus non-closure of animal bite wounds.</p><p class="abstract"><strong>Methods:</strong> This is a prospective randomized study. Patients were divided into 2 groups. Group A consisted of patients with non-closure of wounds and group B with primary closure of wounds. Patients were followed up for wound healing time, infection and cosmesis. </p><p class="abstract"><strong>Results:</strong> This study consists of 540 patients (323 males and 217 females). The common age group was paediatric and geriatric age. Most common animal bite was from dogs. The average healing time in non-infected wound in group A versus group B with Lackman’s I and II grading was 10.5±1.25 and 12.5±1.5 days versus 7±1.25 and 8.5±1.5 days respectively. There were 19 cases in group A and 17 cases in group B with infection which subsided with antibiotics in 24 hrs. Cosmesis graded on VSS was better in group B (average 4.03±1.5) as compared to group A (average 2.44±0.185). Only one patient from group A with Lackman’s grade II contacted rabies died 2yrs after the bite.</p><p class="abstract"><strong>Conclusions:</strong> Animal bite wounds over head and neck were found to be more common in paediatric and geriatric population who are more vulnerable. Infection and spread of rabies virus through these wounds can be prevented by thorough debridement and cleaning whereas primary suturing helps in achieving early wound healing and better cosmesis producing a socially and functionally acceptable scar.</p><p class="abstract"> </p>

Management of dog bite wounds: Our protocol and experience with early surgical intervention

“…Dog bite wounds should be treated as surgical wounds especially Category 3 dog bites. These patients usually belong to either paediatric and geriatric populations [9,10]. Probable reason for children and old age persons having an increased incidence of dog bite is lack of self-defence.…”

“…Taking extra care of children and keeping a simple stick in the hands of old age people while they are walking would help in reducing the incidence of dog bite. Most dog bite victims are males, probably due to the male dominant society in developing countries due to which males are involved more in outdoor work where they are more vulnerable for such injuries [9,10].…”

“…The management of dog bite wounds has evolved over the years. More recently, there has been a move to more early and definitive treatment, with authors advocating early washout and debridement of wounds and primary closure [6][7][8]10]. These changes have arisen from findings that the infection rate increased if treatment was delayed following injury; that debridement reduced the incidence of infection by as much as 30-folds; and that primary treatment produced the best cosmetic and functional results.…”

“…However, there are recent publications indicating that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar [8][9][10].…”