Dog Bites and Plastic Surgery

A case I recently had was to repair a young child with dog bite lacerations to her face.  The mother was with her at an outdoor event, and the dog was leashed and held by its owner, who said afterward that the dog is very friendly and has never attacked anyone.  Until it did.  I have heard similar stories many times.  The following is based on my personal experience only, as a plastic surgeon in Santa Barbara and previously in Portland, so I’m not going to report statistics.  Others in my profession may have different experiences, and emergency room physicians may also have different experiences and opinions.

This is the season that dog bites become more common – more people spending more time outdoors: kids playing, dogs running around, dogs tied to chairs outside stores, etc.  Many dog bite injuries, including many extremity injuries, are handled by the emergency room physicians, so my observations may be biased based on the fact that I am usually called in to the emergency room at Cottage or Goleta Hospitals for facial injuries. 

Children tend to get bit in the face, and while adults can be bit in the face too, there seem to be more hand and leg bites to adults.  I suppose the face/neck being the natural target for dog, the child’s face is more accessible than the face of a standing adult.  And I say face as opposed to neck – I see many isolated face injuries, but not many isolated neck injuries.  Again, that could be a selection bias for me as a plastic surgeon – an emergency room physician who sees everyone may have a different take on it.

Of the dog bites involving the face, most of these involve the lips, nose, and eyelids, in that order.  They may involve all of those.  Ear injuries are rare.  There may be puncture wounds from fangs, but typically there are irregular, tearing type lacerations.  These are often full thickness injuries of the lips and nose.  Parents often ask if there will be scars, or if there is anything that can be done to eliminate scars.  They are often perplexed that as a plastic surgeon, I tell them that yes, there will be scars, and no, nothing will make them go away completely (see a previous blog post on scars here).  There are things that may mitigate the scar, but there will always be a scar whenever a significant thickness of the skin has been injured, whatever the cause.

I have definitely seen patterns of injury based on dog breed.  Despite the commonality of Pit Bulls and their bad reputation, I have seen very few dog bites from them.  However, the ones I have seen have often been devastating, even life threatening.  I think that is a case where the dog’s upbringing is everything: they are a safe dog unless bred to be aggressive.  A different situation is the Chow Chow.  These are never (to my knowledge) bred to be purposefully aggressive, yet I have seen a disproportionate number of dog bites from Chows, even against their owners and family members.  I would urge anyone considering getting a Chow: don’t.  Now before any Chow owner emails me or writes me an angry comment, please re-read the first paragraph.  On the other side, a Labrador Retriever is a very common dog.  Yet I don’t think I have ever seen a dog bite from a Labrador.  So there you have it, when considering adding a dog to the family, Labrador – yes, Chow – no.  And when your daughter wants to go pet the pretty Chow tied up outside the store, do not let her get near it! The Lab, OK.  Those breeds represent the opposite extremes in my opinion, and certainly there are countless breeds and mutts, with countless temperaments, good and bad. 

Teach children how to approach dogs safely.  Many children will pet a dog abruptly, perhaps bringing a raised hand down onto the dog, or grabbing a dog from behind, or wrapping their arms around the neck of the dog.  The dog may be instinctively programmed to perceive these as aggressive actions, and react accordingly.  Be cautious - any animal has the potential to behave in both predictable and unpredictable ways, just like humans.   

Douglas J. Mackenzie, M.D., F.A.C.S.

Pacific Plastic Surgery, Santa Barbara, CA