Management of dog bite avulsions of the lip vermilion

Conservative management of large avulsions of the lip and local landmarks

Large lip avulsion injuries that involve significant tissue loss to the lip vermilion and other local landmarks can often pose a surgical dilemma for the reconstructive surgeon. Immediate reconstruction of these injuries are frequently performed using local flaps and adjacent tissue transfer to close the defect, but these repairs frequently suffer from the unfortunate consequence of increased associated scarring and further permanent distortion of the local anatomy. We present 2 patients sustaining dog bite injuries associated with extensive traumatic tissue loss to the lip vermilion and other local landmarks. These patients were treated conservatively with excellent functional and cosmetic results. A single minor surgical revision of 1 patient's cupid's bow was performed 1 year after injury. In cases of significant traumatic avulsion involving the lip vermilion and the perioral composite soft tissue, even with injuries including delicate anatomic landmarks, healing by secondary intention can be instituted as the initial treatment of choice in younger patients, often providing optimal results.

Dogs that bite

OBJECTIVE

To study the circumstances of dog bites and identify risk factors.

DESIGN

Postal questionnaire survey and case note review of victims of dog bites referred between 1982 and 1989.

SETTING

One referral based regional plastic surgery unit.

PATIENTS

146 consecutive patients referred for primary treatment of dog bites, for whom current addresses were available for 133, 107 (81%) of whom returned the questionnaire.

RESULTS

The male to female ratio was 74:72; 79 (54%) patients were aged below 15 years. The commonest dogs producing bites were Staffordshire bull terriers (15 cases), Jack Russell terriers (13), medium sized mongrels (10), and Alsatians (nine). 82 of 96 (85%) dogs were male. 29 of 47 (62%) adults were bitten at home and 45 of 60 (75%) children at a friend's, neighbour's, or relative's house. 91 of 107 (85%) bites occurred in the dog's home. Bites occurred during playing with 13 (12%), petting 14 (13%), or waking 16 (15%) dogs. 45 (42%) bites were judged as unprovoked. 32 bites were identified as severe and 11 attacks as sustained.

CONCLUSIONS

Most victims are bitten by male dogs which they either own or have had frequent contact with, and the bite occurs in the dog's home.