A dog bite is a common injury that carries unique risks, primarily due to the introduction of bacteria from the animal’s mouth deep into the tissue. This contamination significantly elevates the risk of infection, which is the primary concern following a canine encounter. The decision of whether a wound needs stitches is complex and prioritizes infection control over simple wound closure.
Immediate Steps Following a Dog Bite
The first action after a dog bite is to ensure safety and immediately begin wound management, focusing on cleaning the injury thoroughly. Start by gently applying pressure with a clean cloth or sterile gauze to any actively bleeding site to help slow the blood flow. If the bite is located on an arm or leg, elevating the injured limb above the level of the heart can also assist in controlling the bleeding.
Next, the wound must be cleaned immediately and meticulously using mild soap and copious amounts of running water for a minimum of five to ten minutes. This extensive irrigation is a highly effective way to physically flush bacteria, debris, and foreign material out of the wound. Avoid harsh cleaning agents like alcohol or hydrogen peroxide, which can damage the healthy tissue and potentially slow the healing process.
Once the wound is clean and bleeding has stopped, a thin layer of antibiotic ointment can be applied, and the area should be covered with a clean, sterile bandage. Even bites that seem minor and only break the skin should be evaluated by a healthcare professional within 8 to 24 hours. The risk of severe infection is a real possibility, especially for those who are immunocompromised or have underlying conditions like diabetes.
Factors Determining Wound Closure
Not all dog bites require or benefit from stitches; in many cases, closure is avoided to mitigate the risk of trapping bacteria. Medical professionals classify dog bite wounds as low-risk or high-risk, which determines the approach to stitching. High-risk wounds, such as deep, narrow puncture wounds, are rarely stitched. Closing the surface traps bacteria deep inside, creating an ideal environment for infection to flourish.
Low-risk wounds are usually clean, gaping lacerations, especially those on the face or head, which have excellent blood supply. These wounds may be closed primarily with sutures to minimize scarring and improve cosmetic outcomes, but only after meticulous cleaning and debridement. The location of the injury is a significant factor. Bites to the hands and feet are considered high-risk due to the dense concentration of tendons and joints, and they are left open to heal by secondary intention.
The time elapsed since the bite occurred is also a factor. Wounds presenting more than eight to twelve hours after the injury are left open because the risk of bacterial colonization and infection becomes too high to safely close the wound. While primary closure is avoided for most body locations, a medical provider may opt for “delayed primary closure.” This involves thoroughly cleaning and monitoring the wound for several days before stitching, provided no signs of infection appear.
Preventing Infection and Systemic Illness
Medical follow-up extends beyond managing the injury site to addressing potential systemic illness. Prophylactic antibiotics, most commonly a combination like amoxicillin-clavulanate, are often prescribed for three to five days, particularly for high-risk bites. This preemptive treatment is recommended for deep puncture wounds, injuries to the hands, feet, or face, and for patients with compromised immune systems or liver disease.
Checking the patient’s vaccination history is another important step, as a tetanus booster may be necessary following a dog bite. Tetanus bacteria, which cause a severe neurological illness, can enter the body through contaminated wounds. A booster shot is typically recommended if a patient has not received one in the past ten years, or within the last five years if the wound is considered deep or dirty.
The risk of rabies must also be assessed, as it is a near-universally fatal viral infection transmitted through the saliva of an infected animal. If the biting dog is a healthy, owned domestic pet, it is confined and observed for ten days to ensure it does not develop signs of the disease. If the animal is a stray, wild, or unavailable for observation, a healthcare provider will consult with local public health officials to determine if post-exposure prophylaxis is necessary.