Friday, August 23, 2013

Suture Everything Closed

Management of dog bites still exhibits significant variability.  Antibiotics, traditionally generally prescribed, are only selectively necessary.  Another element of mythology, primary closure of wounds for optimal cosmesis, is the subject of this trial.

These Greek authors randomized 182 patients to either primary suturing or non-suturing of traumatic bite lacerations.  Obviously, the lacerations receiving primary closure had much improved cosmetic outcome.  The infection rate of suturing was 9.7% vs. 6.9% without, and this study was underpowered to confirm whether this small difference occurred by chance alone.  The main predictor of subsequent infection was treatment >8 hours after injury.  All patients, unfortunately, received local scrubbing with povidone-iodine and were prescribed amoxicillin/clavulanic acid, neither of which were likely helpful.


I think it's absolutely reasonable to approximate wound edges for dog bite lacerations after gentle and thorough cleansing.  This study doesn't provide any truly conclusive guidance for wounds >8 hours old – as they had similarly poor outcomes, regardless – other than to offer information to patients on their sub-optimal prognosis.


"Primary closure versus non-closure of dog bite wounds. A randomised controlled trial"
http://www.ncbi.nlm.nih.gov/pubmed/23916901

2 comments:

  1. Important point to be made. Either close it or leave it open. Don't "loosely" approximate it as it does nothing for cosmesis or drainage.

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  2. For clean wounds wound infection is 5% so 7-10% for bite wounds does not sound to bad...there are various degrees of badness with bite wounds to

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