Management of facial and periocular dog bites:
a review of 104 cases
Andre S. Litwin
Received: 10 April 2014 /Accepted: 24 June 2014 /Published online: 20 July 2014
Springer-Verlag Berlin Heidelberg 2014
Background Dog bites are a frequent cause of facial and
periocular injuries in both children and adults. This aim of
this study is to review current practice in the management of
facial and periorbital dog bite injuries and to examine the
current evidence-base for such treatment strategies.
Methods Five hundred eighty-seven patients with dog bite
injuries requiring surgical intervention were identified from
operating theatre records in one tertiary centre over a 9-year
period. A retrospective case note review of 104 patients with
facial and periorbital dog bite injuries was performed. Data on
patient demographics, type of injury, treatment, and outcome
was collected and analysed.
Results The majority of patients were children, with a mean
age of 11 years (range 1–91 years). Injuries involved the cheek
in 57 cases (55 %), eyelids in 17 cases (16 %), lips in 24 cases
(23 %) and nose in 8 cases (8 %). No facial fractures, cana-
licular, or globe injuries were recorded. All patients underwent
irrigation, debridement, and primary wound closure. Surgical
repair occurred within 24 h in 19 cases (18.2 %), within 48 h
in 71 cases (68.3 %) and within 5 days in 14 cases (13.4 %).
Three patients (2.9 %) developed a wound infection. Two
patients (1.9 %) required scar revision surgery.
Conclusions Periorbital and facial dog bite injuries may result
in considerable morbidity. However, the majority of injuries are
superficial and canalicular injury and bony injury is uncom-
mon. Early wound irrigation, debridement and primary closure
results in a good cosmetic outcome with a low risk of infection.
Level of Evidence: Level IV, risk/prognostic study.
Keywords Dog bite
Dog bites are common and pose a significant public health
problem in the UK. Approximately, 31 % of households in the
UK own dogs  and in 2011–12, 6,450 admissions to hospital
for serious dog bite injuries were recorded in England alone.
Serious dog bite injuries disproportionately affect children,
with one in six hospital admissions for dog bites involving a
child under 10 years old. Young children are also more likely to
sustain periorbital and facial injuries from dog bites .
Facial injuries commonly involve the periorbita, nose,
cheeks and lips . Periorbital injuries may involve full thick-
ness lid defects, canthal avulsions and canalicular lacerations
[4–7]. Surgical repair is imperative to restore the function of
the eyelid and lacrimal system and ensure that the eye is
protected. However, there is a paucity of evidence for the
optimum management of facial and periorbital dog bite inju-
ries and treatment varies from centre to centre.
This study presents our data on 104 facial and periorbital
dog bite injuries requiring surgical intervention in one tertiary
referral centre for both plastic and oculoplastic disease. We
examine the evidence for traditional treatment strategies for
periorbital and facial dog bite injuries and the controversies
surrounding irrigation and wound debridement, early direct
wound closure and adjuvant antibiotic use. We present our key
principles for the management of these injuries, in light of our
experience and outcomes.
Material and Methods
Clinical coding was used to identify patients admitted to the
Queen Victoria Hospital with a dog bite injury over a 9-year
period from July 2001 to August 2010 and those identified were
A. S. Litwin
R. Malhotra (*)
Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East
Grinstead, West Sussex RH19 3DZ, UK
Department of Plastic Surgery, Queen Victoria Hospital NHS Trust,
East Grinstead, West Sussex, UK
Eur J Plast Surg (2014) 37:595–598