title: Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area.
abstract: BACKGROUND
  Facial dog bite injuries pose a significant public health problem.
  
  
  METHODS
  Seventy-five consecutive patients (45 males, 30 females) treated solely by plastic surgery service for facial dog bite injuries at a Level I trauma center in the Denver Metro area between 2006 and 2012 were retrospectively reviewed. The following information were recorded: breed, relationship of patient to dog, location and number of wounds, the duration between injury and surgical repair and dog bite incident, type of repair, and antibiotic prophylaxis. Primary end points measured were wound infection, the need for revision surgery, and patient satisfaction.
  
  
  RESULTS
  Ninety-eight wounds in the head and neck region were repaired (46 children; mean age, 6.8 years) and (29 adults; mean age, 47.3 years). Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries. The duration between injury and repair ranged from 4 hours to 72 hours (mean [SD], 13.7 [10.9] hours). The majority of bite wounds (76 of 98) involved the cheek, lip, nose, and chin region. Direct repair was the most common surgical approach (60 of 98 wounds) (p < 0.05). There was no statistically significant association between wounds needing reconstruction versus direct repair according to dog breed (p = 0.25). Ten wounds required grafting. Twenty-five wounds were managed by one-stage or two-stage flaps. Only three patients (3.06 %) underwent replantation/revascularization of amputated partial lip (n = 2) and of cheek (n = 1). There was one postoperative infection. Data from five-point Likert scale were available for fifty-two patients. Forty patients were satisfied (5) with the outcome, while five patients were somewhat satisfied (4), and seven were neutral.
  
  
  CONCLUSIONS
  Availability of the plastic surgery service at a Level I trauma center is vital for the optimal treatment of facial dog bite injuries. Direct repair and reconstruction of facial dog bite injuries at the earliest opportunity resulted in good outcomes as evidenced by the satisfaction survey data and low complication rate.
  
  
  METHODS
  Therapeutic study, level V. Epidemiologic study, level III.
authors.affiliation: From the Plastic and Reconstructive Surgery (R.G., J.A.), and Oral Maxillofacial Surgery (M.G.), Denver Health Medical Center, University of Colorado Health Sciences Center, Denver; and Colorado Health Outcomes Program (COHO) (M.B.), University of Colorado, Aurora, Colorado.
authors.forename: Raffi
authors.initials: R
authors.lastname: Gurunluoglu
authors.forename: Mark
authors.initials: M
authors.lastname: Glasgow
authors.forename: Jamie
authors.initials: J
authors.lastname: Arton
authors.forename: Michael
authors.initials: M
authors.lastname: Bronsert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000818:Animals; D001733:Bites and Stings / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003120:Colorado; D004285:Dogs; D005151:Facial Injuries / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014193:Trauma Centers; D014505:Urban Population; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult