I read with interest the article ‘Surgical delay in the management of dog bite injuries
in children, does it increase the risk of infection?’ by Akthar et al.,
1
on a very common presentation to the paediatric plastic surgery departments. Although
it was a retrospective study the data were well collected and results clearly discussed.
I would like to make some suggestions on a few aspects of the study.
- (1)The study shows a reduced rate of infection in the group of patients operated on 12 h after injury, when they were operated in accordance with existing CEPOD guidelines. In this correspondent's opinion, this should not be taken as a general rule, but each patient should be assessed individually. The lower rate of infection in this group could well be due to the fact that cases which waited more than 12 h may have represented the less severe end of the injury spectrum. Conversely, the patients who were operated on within 12 h may have sustained more severe tissue damage and hence required surgery within 12 h. No comparison was made between the rate of infection and the severity of injury, which would have been more informative.
- (2)The authors have classified dog bite injuries, but this does not exactly describe the severity of tissue damage, which could have been one of the criteria for timing of the operation. Previous papers used a classification based on the severity of injury which was more informative.2,3
- (3)The statement that 84% of dog bites in this study had been cleaned and dressed in referring A&E departments cannot lead to the assumption that a uniform treatment method was used. The methods of treatment may have differed between centres, as no fixed protocols were in place for initial management of dog bites in particular.
- (4)The question regarding use of antibiotics is always a point of discussion. Though studies have shown no difference with the use of antibiotics, it persists as common practice in most units.4
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References
- Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection?.J Plast Reconstr Aesthetic Surg. 2006; 59: 80-85
- Dog bites of the face: a 15-year review.Br J Plast Surg. 1983; 36: 315-318
- Treatment of facial dog bite injuries in children: a retrospective study.J Pediatr Surg. 2000; 35: 580-583
- Antibiotics to prevent infections in patients with dog bite wounds: a meta-analysis of randomised trials.Ann Emerg Med. 1994; 23: 535-540
Article info
Publication history
Published online: February 02, 2007
Accepted:
November 27,
2006
Received:
June 22,
2006
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
