title: Management of vascular trauma from dog bites.
abstract: BACKGROUND
  Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations.
  
  
  METHODS
  From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study.
  
  
  RESULTS
  Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up.
  
  
  CONCLUSIONS
  Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Department of Medicine, Division of Cardiology, Indiana University School of Medicine, Indianapolis, Ind. Electronic address: aakingba@iupui.edu.
authors.forename: A George
authors.initials: AG
authors.lastname: Akingba
authors.forename: Eric A
authors.initials: EA
authors.lastname: Robinson
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Jester
authors.forename: Brian M
authors.initials: BM
authors.lastname: Rapp
authors.forename: Anthony
authors.initials: A
authors.lastname: Tsai
authors.forename: Raghu L
authors.initials: RL
authors.lastname: Motaganahalli
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dalsing
authors.forename: Michael P
authors.initials: MP
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001158:Arteries / Q000293:injuries / Q000601:surgery; D001733:Bites and Stings / Q000150:complications*; D002648:Child; D003646:Debridement; D004285:Dogs; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014680:Veins / Q000293:injuries / Q000601:surgery; D014946:Wound Infection / Q000209:etiology / Q000628:therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents