Dog Bites: A Hand Surgeon’s Perspective on Treating These Common Injuries
By Dr. Oren Michaeli, DO – Board Certified General Surgeon, Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery
Introduction
Dog bites are a surprisingly common injury, especially to the hands, which are often the first point of contact in an attack. While some bites may appear minor, even small puncture wounds can pose significant risks of infection, nerve damage, or long-term functional issues if not treated properly. As a hand surgeon, I approach dog bites with a focus on minimizing infection risk, preserving hand function, and optimizing healing. Proper treatment often requires more than just cleaning and bandaging the wound—especially when delicate structures like tendons, nerves, or joints are involved.
Understanding the Risks of Dog Bites
Dog bites are unique injuries for several reasons:
Deep Puncture Wounds: Dogs’ teeth can puncture deep into soft tissues, often reaching tendons, nerves, or joints, while leaving only a small surface wound.
High Risk of Infection: Dogs’ mouths carry bacteria such as Pasteurella, Staphylococcus, and Streptococcus, which can quickly lead to infections if the wound is not properly cleaned.
Functional Impact: The hands are complex anatomical structures with many small bones, tendons, ligaments, and nerves packed into a small space. Even minor damage to these structures can lead to long-term issues with mobility or sensation.
Secondary Complications: Infections like cellulitis or abscesses can develop quickly, and in rare cases, untreated bites may lead to sepsis or necrotizing fasciitis.
Initial Steps After a Dog Bite
If you or a loved one experiences a dog bite, it’s essential to take the following steps immediately:
Wash the Wound: Clean the area with soap and water to reduce the bacterial load. Avoid scrubbing too harshly, as this can further traumatize the tissue.
Control Bleeding: Apply gentle pressure with a clean cloth or bandage.
Seek Medical Attention: Even seemingly minor bites should be evaluated by a healthcare professional, especially if the bite involves the hand, where infections can spread quickly.
Document the Incident: If the dog’s vaccination status is unknown, ensure the animal is reported for rabies evaluation.
A Hand Surgeon’s Approach to Dog Bite Treatment
As a hand surgeon, my primary goals in treating dog bites are to prevent infection, assess and repair any structural damage, and promote proper healing. Here’s how I typically manage these injuries:
1. Wound Irrigation and Debridement
Enlarging the Wound: For small puncture wounds, I often slightly enlarge the wound to allow for thorough irrigation. This ensures that bacteria or debris deep within the tissue are removed.
Copious Irrigation: The wound is washed out with large volumes of saline or other sterile solutions to flush out contaminants.
2. Leaving the Wound Open (Secondary Intention Healing)
In many cases, I recommend leaving the wound open to heal by secondary intention, meaning it heals from the inside out. This approach allows drainage of any residual bacteria or fluid, reducing the risk of abscess formation.
Closing the wound too soon can trap bacteria inside, increasing the likelihood of infection.
3. Antibiotic Therapy
Augmentin (Amoxicillin-Clavulanate): This broad-spectrum antibiotic is typically the first-line choice for dog bite injuries because it effectively targets common bacteria found in dog saliva, including Pasteurella multocida.
For patients allergic to penicillin, alternative antibiotics such as doxycycline or clindamycin combined with ciprofloxacin may be prescribed.
The typical duration of antibiotics is 5–7 days, though this may be extended for deeper or more severe injuries.
4. Assessing for Structural Damage
Dog bites to the hand can injure tendons, nerves, joints, or even bones. I carefully evaluate the wound to determine if any of these structures are involved.
Imaging, such as X-rays, may be needed to rule out fractures or detect foreign bodies like tooth fragments.
5. Tetanus and Rabies Precautions
Tetanus: If the patient’s tetanus vaccination is not up to date, a booster is administered.
Rabies: If the dog’s vaccination status is unknown, rabies post-exposure prophylaxis (PEP) may be necessary.
When Surgery Is Necessary
In some cases, surgical intervention is required for dog bites to the hand. This may include:
Exploration and Repair: If the bite has injured a tendon, nerve, or joint, surgery may be needed to repair the damage.
Drainage of an Abscess: If an infection develops despite initial treatment, the wound may need to be surgically opened and drained.
Debridement of Infected Tissue: In severe cases, infected or necrotic tissue may need to be removed to prevent the infection from spreading.
Preventing Long-Term Complications
Proper treatment of a dog bite is critical to avoid complications like:
Infection: Prompt irrigation and antibiotics significantly reduce the risk.
Scarring: Secondary intention healing minimizes the risk of trapped bacteria but may leave a visible scar. Depending on the wound’s location, scar revision may be considered later.
Functional Impairment: If the bite has affected tendons, nerves, or joints, physical therapy may be required to restore mobility and strength.
Why Early Intervention Matters
Treating dog bites properly from the outset can prevent a cascade of complications. A small puncture wound that appears minor can develop into a serious infection requiring hospitalization or extensive surgery if left untreated.By addressing the injury early, we can minimize risks and promote optimal healing.
Why Choose Dr. Oren Michaeli at Hand, Nerve & Microsurgery PC?
Expertise in Complex Hand Injuries: As a fellowship-trained hand surgeon, I specialize in treating injuries that involve delicate structures like tendons, nerves, and joints.
Thorough, Patient-Centered Care: Every dog bite is different, and I take the time to tailor treatment to your specific injury, ensuring the best possible outcome.
Advanced Techniques: From minimally invasive procedures to state-of-the-art wound care, I use the latest tools and approaches to optimize healing.
Comprehensive Support: My team will guide you through every step of the process, from initial treatment to follow-up care, including help with insurance claims if applicable.
Scheduling a Consultation
If you’ve suffered a dog bite, don’t wait to seek medical attention—especially for injuries to the hand. Early evaluation and treatment are key to preventing infection and preserving function.
Phone: (212) 540-4263
Email: Info@handnervemicrosurgery.com
Office: 570 Sylvan Ave, 2nd Floor, Englewood Cliffs, NJ 07632
