Background: The traditional teaching is to leave dog bite wounds open, allowing them to heal by secondary intention or having them closed in theatre after a thorough wash-out. The idea was that this reduced the risk of infection. The studies that led to this approach, however, have many methodological problems and are at least 30 years old. Recent research has looked at primary closure.

 

 

Paschos NK, Makris EA, Gantsos A, Georgoulis AD. Primary closure versus non-closure of dog bite wounds. A randomised controlled trial. Injury 2014;45(1):237-40

 

 

The paper: An RCT involving 168 consecutive patients with dog bite injuries. Each had their wounds cleaned using high-pressure irrigation and iodine and each received a course of prophylactic antibiotics. They were randomised to have their wounds sutured closed or left open, and were followed up at weeks 1 and 4 post-injury to determine the rate of infection and the cosmetic appearance of the wound. The overall infection rate was 8.3%, and there was no significant difference between the two groups. The cosmetic appearance at 4 weeks (independently assessed by a surgeon using the Vancouver Scar Scale) was significantly better in the sutured group.

 

 

The bottom line: This study is probably the best evidence to date (it's hard to see how they could have improved this type of trial - you can't blind the clinicians!). If dog bite wounds are carefully cleaned and debrided, and if they are not too large or complicated, it seems reasonable to close them in the ED.