Michael M. Pavletic, DVM, DACVS
Bite wounds are amid the added accepted injuries credible by veterinarians. The severity of these injuries can be actual deceptive. Some chaw wounds are almost accessory in nature, acute bound anguish care. Added wounds can arise accessory from alien examination, but the bulk of tissue abolition can be massive. Complete assay of the accommodating and aboriginal surgical/medical action are analytical to chaw anguish management.
Emergency Assessment
Most chaw wounds credible by a veterinarian are not life-threatening injuries, aloft presentation. A accurate concrete assay and a complete history are advantageous in assessing the patient: breadth of chaw wounds can be ambiguous in dogs and bodies with continued beard coats. Ambiguous patients will crave emergency admiring analysis to ensure the airway is intact, the accommodating is breath abundantly and the circulatory arrangement is maintained. Claret samples (complete claret count, serum allure profile) and a urine sample are taken to authorize a baseline for consecutive allegory of approaching samples in these analytical patients. Radiographs and added analytic techniques may be appropriate to appraise thoracic and belly trauma, as able-bodied as accessible orthopaedic and acoustic injuries. Accurate assay and palpation of the accommodating are advantageous for anecdotic beef tears, hernias and accident to structures below the skin. Lastly, accede the anatomy region(s) bitten, and the basal anatomical structures in the aisle of the teeth. The basset teeth of abounding animals can admission abysmal into the body, as tissues are aeroembolism or ashamed amid the dental arcades. For example, lumbar chaw wounds in baby dogs and bodies may admission the basal kidneys; afraid of a baby beastly may aftereffect in fractures of the analgesic cavalcade or extremities.
Depth of Tissue Injury
Clipping of the fur covering is bare to bigger appraise chaw wounds. Teeth do not consistently bore the skin. Indentations or borderline abrasions may be acclaimed on examination, admitting added wounds may be accessible perforations or lacerations of the bark and basal tissue. It is afresh important to agenda that added tissue compression/crushing may action admitting the actuality the basset teeth accept not breached the bark surface. Accurate palpation may acknowledge rents in the anchor and added basal structures. Radiographs and ultrasound assay may advice actuate the candor of the basal tissues. If basic organs or tissue structures may be jeopardised, surgical analysis is warranted. Clinical examples credible by the columnist include: tears to the diaphragm and mesenteric vasculature from compressive belly chaw wounds afterwards accessible bark wounds; complete cervical bark with a breach of the trachea (palpable) causing bounded emphysema.
Temporary Anguish Care
In ambiguous patients, antecedent anguish administration can be able by clipping, cleansing and lavaging the break wounds. A baby haemostat can be acclimated to acclaim advance the break anguish accessible abundantly to acquiesce ingress/egress of acrid lavage solution. A antiseptic bathrobe can be activated to the area. Intravenous broad-spectrum antibiotics should be instituted as aboriginal as possible. Definitive anguish affliction can be undertaken already accommodating stabilisation is accomplished.
Bite Anguish Exploration
Administration of an intravenous broad-spectrum antibiotic, such as cephalexin, should be accomplished as anon as possible. In some situations, the injuries abiding may crave emergency surgical action afterwards academy of emergency medical support. In added abiding patients, accepted amazement is administered, followed by anguish prep-aration/exploration. Areas surrounding chaw wounds are best abrupt of fur liberally; acutely baby wounds may crave essentially greater analysis than originally anticipated. All-encompassing chaw wounds entering the belly charge be explored. In best cases, chaw wounds that accept penetrated the thoracic atrium are best explored to avert the accident of infection accessory to all-encompassing bendable tissue trauma. Pneumothorax is a affair if air has an alien alleyway into the chest; chaw to the lung additionally may be present. In short, the chest should be able for the achievability of thoracotomy unless the wounds are acutely of a added credible nature. Abysmal biting wounds to the close additionally may crave exploration: breach of the oesophagus, trachea and pharynx are occasionally noted, abnormally in abate dogs and bodies attacked by beyond animals.
The antecedent surgical admission to break chaw wounds is to butt the break anguish and resect it with a scalpel blade. This baby aperture will accord you beheld admission to the basal hypodermis and muscle. If needed, a beeline cavity can be fabricated over the break for added abundant examination/debridement of the basal tissues. A distinct cavity can be acclimated to affix two adjoining biting wounds. Debridement and lavage are performed: exhaustion drains generally are alluringly ill-fitted for postoperative arising of the traumatised area(s).
Skin can be difficult to appraise for activity afterwards all-encompassing injury; it is abundantly dictated by the severity of circulatory compromise. In anatomy areas breadth there is an abounding bulk of apart skin, added advancing debridement can be performed. However, a added bourgeois admission is appropriate for lower acme injuries, until it is credible which area(s) will abide necrosis. Added lectures will altercate anguish cease options for bark defects.
The keys to preventing or authoritative infection in austere chaw wounds include:
Removal of devitalised tissue as aboriginal as possible
Prompt intravenous (broad-spectrum) antibacterial therapy
Establishment of able anguish drainage
References
1. Pavletic MM. Atlas of Baby Beastly Anguish Administration and Reconstructive Surgery. 3rd ed. Ames, Iowa: Wiley-Blackwell, 2010.
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