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Dr. Barry Eppley

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Posts Tagged ‘facial dogbite injuries’

Scar Revisions of Dogbite Injuries in Children

Monday, April 29th, 2013


One of the most common traumatic facial injuries to deal with in children as a plastic surgeon are dogbites. There are a lot more common than most people think and, fortunately, are usually minor and result in no significant scarring. They often are just ‘nips’ and don’t require any major reconstructive surgery.

But having been at a University for many years before entering private plastic surgery practice, I had the unfortunate opportunity to see more than my share of major dogbite injuries to the face…the vast majority being in children. I reported my pediatric dogbite experience in the March 2013 issue of the Journal of Craniofacial Surgery over a ten year period while covering a major children’s hospital. From 1995 to 2005, I treated over 100 major dogbites the face, scalp and neck in children that required surgical repair in the operating room. The average age of the patients was 6 years old and was fairly evenly split between boys and girls. In most cases the dog was known to the patient or family and was classified as ‘provoked’. The most common dog breeds were Pit Bull, Chow, German Shephard and Doberman Pinscher. Most injuries could be primarily closed but a few did need skin grafts or other reconstructive surgery.

Contrary to popular perception, only one patient developed an infection. Surprisingly, only one patients was left with a permanent facial nerve weakness. In more than three-fourths of the patients, scar revisions were needed and another third needed more than one scar revision.

More than one-third of these dogbite cases involved legal action, either against the dog’s owner or their insurance companies. Because of the high litigation rate and possible denial of insurance claims for subsequent reconstructive procedures, I would advise all plastic surgeons and the families to keep meticulous records, including photographs, of the dog bite injuries.

Like many traumatic injuries dog bites to the face often require repeated plastic surgery procedures to obtain the optimal aesthetic outcome. One should not try and be too clever at the time of initial injury repair with complex closure decisions as the tissue quality often precludes the optimal aesthetic result from the primary repair.

Dr. Barry Eppley

Indianapolis, Indiana

Prevention Of Dogbite Injuries To The Face In Children

Sunday, May 22nd, 2011

Dogbites are an unfortunate risk to which all children are potentially exposed. Beyond the trauma of the experience, permanent scarring almost always occur which can leave lifelong marks to be seen by all if it occurs on the face. With millions of dog bites occurring per year, plastic surgeons are involved in a lot of repairs particularly when it has occurred on the face. Plastic surgery involvement is so significant that last week was Dogbite Prevention Week sponsored by the American Society of Plastic Surgery.

Having done many hundreds of facial dogbite repairs and secondary reconstruction, there are some very common trends. A disproportionate number occur in children from ages five to nine, the biting dog is rarely an unknown one, and many such injuries turn into legal and insurance issues. The common age of patient injury is a reflection of the naïve and innocent nature of that age and their view that dogs are playful and fun. Most dogbites occur in a family, neighbor or relative’s dog where the familiarity promotes unintentional behaviors that are predisposed to evoke their protective natures. Because many dogbites occur on the owner’s home, insurance battles are certain to ensue that frequently involve lawyers. It is not uncommon for me to see referrals from attorneys to evaluate dogbite scars and get an estimate on the cost of scar revision.

That being said, prevention of dogbite injuries can avoid many of these problems. These are the most significant ways to avoid a dogbite injury to a child. These are based on many of the reasons or circumstances I have heard that were given for what was going on when the injury happened.

1) Don’t play aggressive games with a dog. They may not see it as a game.

2) Don’t mess with a dog while eating or play keep away games with food. They are very protective of food and aggressive about getting it.

3) Do not jump on a sleeping dog or surprise it from behind. Give it plenty of warning that you are around.

4) Do not attempt to kiss a dog, particularly face-to-face. Dogs tend to strike defensively when confronted directly.

5) Do not hug, squeeze, or ‘pin’ a dog in any way. This is likely not to be interpreted as play to them.

6) Keep away from a dog with puppies or do not attempt to take a puppy away or get between a mother and her puppy.

7) Do not attempt to pet a dog, particularly an unfamiliar one, unless you let them sniff you first.

While some dogbites can just not be prevented or occur for no discernible reason, these behaviors which are common in children can unintentionally cause a defensive maneuver by a dog. Defensive maneuvers in dogs are usually a biting response and their nature is to go for the face and neck.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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