Surgical treatment of facial bite wounds in children: the story of our young patient

What to do if a child is bitten by a dog?

This story began in the private sector of Odessa, when a teenage girl was walking to the bus stop. At that time, her neighbor was leaving the yard, and his akita-inu, which was not tied, took advantage of the moment, jumped out into the street and ran in the direction of the girl. She had known the dog well for several years, had played with him when he was still a puppy, and could not even think that he intended to attack, so she met him with an open face and did not protect herself either with her arms or her backpack. The dog immediately latched onto her throat. Until the neighbor, seeing what was wrong, pulled the animal away, the dog managed to bite off a large piece of the girl’s face and tear her throat.

The child was immediately taken to the hospital with a torn piece of skin, and I was already called from there.

Just as any firearm should be assumed to be loaded by default, be aware that any dog—whether you’re familiar with it or not—can attack. You see that the dog is running at you – at least cover the throat and face with your hands, bag or other available object. And if you are bitten by a dog on the street, immediately consult a doctor, even if the bite does not look dangerous – perhaps the dog was sick.

How to treat a dog bite before the arrival of an ambulance or a doctor?

Much depends on what and how it happened. If the dog’s bite is shallow, the bleeding is not strong, and the child fell into mud or sand, you can try to carefully wash the wound with water and treat it with hydrogen peroxide. But bitten lacerations of the face are, as a rule, severe arterial bleeding and half-detached flaps of skin, so it is better not to try to treat the wound at all, so as not to damage anything additionally, but to tightly press the fabric (T-shirt, shirt, towel, etc.) to it and firmly keep until arrival at a medical facility or the arrival of an ambulance that will provide first aid for a dog bite. This will most likely stop the bleeding and thereby facilitate the work of the maxillofacial surgeon.

This is exactly what the parents of my patient did, and the bleeding was stopped before arriving at the hospital. She later developed an arterial bleed on the operating table as we began to wash the wound, but by then the specialists and equipment were on hand to close the artery as quickly as possible.

In what cases do you need the help of a maxillofacial surgeon for facial bite wounds

If a child’s face and throat were damaged by a dog bite, the help of a maxillofacial surgeon is needed to treat and close the wound. This is usually not an easy task: due to the uneven edges of bite wounds, it is difficult to sew them up without leaving visible scars, they heal poorly, and suppuration and other complications often occur (even if the animal was healthy). In the future, after the completion of rehabilitation, when the scars are fully formed, you can contact a plastic surgeon about their grinding.

How is the treatment of bite wounds on the face of a child

No two animal bites are the same, so the maxillofacial surgeon must decide on a case-by-case basis how the primary surgical treatment of facial wounds should be performed. In this case, the task was to avoid a through injury and to give an opportunity to restore the child’s own facial tissues due to the replantation of the bitten flap as a biological bandage. Such operations are performed under general anesthesia.

By the time I arrived at the hospital, colleagues had already sent me pictures of the patient, and I was well aware of the seriousness of the situation. The dog bit off a fragment of the girl’s lower lip and cheek measuring about 4×4 cm, which is a large part of her face. Therefore, he immediately went to the operating room.

The question arose, what to do: close the defect by moving a fragment of skin from another area, or try to sew up the torn flap of the cheek and lower lip. It was already a well-chewed piece of tissue that we washed away, and luckily it wasn’t attached to the blood vessels. Hemming such a flap is usually a 100% failure, because there is no chance that it will take root. But I had the opportunity to cut out a fragment of the mucous membrane from the side of the oral cavity, and after suturing the torn tissues, I closed the torn lip wound with it. Thus, the defect ceased to be through. Now I could try to sew up the bitten flap and use it as a biological dressing under which my own tissue could regenerate. In addition, due to the high regenerative abilities of the body, teenagers had a small chance that the flap would take root. The operation was completed in about 1.5 hours.

Rehabilitation after surgical treatment of injuries and bite wounds of the face in children

Then it remained only to carefully observe the healing of the wound and hope for the best. Everything looked fine for the first few days, but then the replanted flap began to get sick: it changed color to a darker and darker color, and the edges began to tear and rise up. I understood that I was losing this flap, but looking under it, I saw that the defect was being covered by its own new tissue. When the flap became necrotic, I removed it. But the goal was achieved: the cheek under him was restored. The area of the defect decreased by 70%, we managed to preserve the contour and innervation of the face. The girl has no paresthesia (loss of sensitivity) and numb areas. Moreover, it was possible to restore the red contour of the lower lip in the corner of the mouth, even with a small margin. Therefore, if the need for correction arises later, we will not have to increase the volume of the lip, which is a more difficult option, but we will have the opportunity to remove the excess.

It has now been 2 months since the operation, and I can say that the situation is good. The scar remained small, and the girl is currently working with a physiotherapist to keep it inconspicuous, soft and tidy. The formation of the scar should be completed 8-12 months after the injury, and then we will be able to choose further tactics for its treatment.

Will marks and scars remain after treatment?

Unfortunately, even the best maxillofacial surgeon is not all-powerful to undo all the consequences of a dog attack. Therefore, the scars after the wound from dog bites will remain, and the child will need to be treated by a physiotherapist so that they are at least inconspicuous. You may need the help of a psychologist to work through your newly acquired fear of dogs.

Is it possible to get rid of scars after biting facial injuries in children?

In 8-12 months after a dog bite, the scar will be complete, and then the maxillofacial surgeon may recommend that you consult a plastic surgeon for its removal. Depending on the appearance of the scar, it can be laser grinding or full plastic surgery.