MAKERER UNIVERSITY

COLLEGE OF VETERINARY MEDICINE ANIMAL

RESOURCES AND BIOSECURITY (CoVAB)



DEPARTMENT OF PHARMACY, CLINICS AND
COMPARATIVE MEDICINCE

SURGICAL MANAGEMENT OF A DOG BITE WOUND IN A SIX YEARS
OLD BITCH MALTESE CROSS


ABDIRIZAK MOHAMED AHMED
10/X/24066/PS



i

DECLARATION
I, Abdirizak Mohamed Ahmed do declare that this surgery report is my own work and has never been
submitted in this University or any other higher institution of learning for the award of a degree.



Signature.. Date ..

















ii






ACKNOWLEDGEMENT
I am very grateful to Professor Johnson Achon, the lead surgeon in this case, for allowing me the
opportunity to work and learn from him during the surgery. My sincere thanks go to the teaching staff of
the department of surgery. Finally, I am thankful to my classmates.
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ABBREVIATIONS
%- Percentage
0
C- Degree Celcius
CoVAB- Collage of Veterinary Medicine, Animal Resources and Biosecurity
I.M- Intramusculat
I.V- Intravenous
Kg- Kilogram
Mg- Miligram
Ml- Mililiter








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TABLE OF CONTENTS
DECLARATION ..............................................................................................................................
ACKNOWLEDGEMENT .............................................................................................................. ii
ABBREVIATIONS ....................................................................................................................... iii
ABSTRACT .................................................................................................................................... v
SURGICAL MANAGEMENT OF A DOG-INFLICTED BITE WOUND IN A MALTESE
CROSS DOG .................................................................................................................................. 1
1. INTRODUCTION ............................................................................................................... 1
2. CASE REPORT ....................................................................................................................... 2
2.1 CASE HISTORY ............................................................................................................. 2
2.2 ANIMAL BIO-DATA...................................................................................................... 2
2.3 PHYSICAL EXAMINATION ......................................................................................... 2
3. THE SURGICAL PROCEDURE ............................................................................................ 4
3.1 PRE-OPERATIVE MANAGEMENT AND PRE-MEDICATION ................................ 4
3.2 THE SURGICAL OPERATION ..................................................................................... 4
4. THE POST-OPERATIVE CARE ........................................................................................... 6
5. DISCUSSION .......................................................................................................................... 7
6. RECOMMENDATION ........................................................................................................... 9
REFERENCE ................................................................................................................................ 10





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ABSTRACT
A 6 years old Maltese cross bitch was brought to the small animal clinic of the Makerere University. The
bitch had a gross swelling on the left side neck, which arose after she was bitten by another dog. The
swelling was surgically managed and then a 7 days antibiotic therapy was subscribed to assist in the
healing process. On the 10
th
post operation day the wound was completely healed.
1


SURGICAL MANAGEMENT OF A DOG-INFLICTED BITE WOUND IN A MALTESE
CROSS DOG
1. INTRODUCTION
Dog bite wounds are a problem commonly documented in veterinary and human medicine and
may account for 1% of human emergency visits and 10% of canine emergency admissions
(Kolata RJ, et al. 1974).
Not all dog bite wounds share similar characteristics; they uniquely vary greatly and the range of
injuries is almost limitless, form simple puncture wounds and lacerations to various
combinations of crush and tears. The force produced by the jaws and related dentition (150-450
ibs./sq) can result in deformation of tissues in the form of puncture, tear, shearing or compression
(Goldstein EJC, et al. 1987).
Bite wounds are more likely to become contaminated by the bacteria from the attackers mouth,
as well as the hair and other debris from the victims skin, which may be driven deeply into the
tissues underneath the skin. This may result in the development of bacterial infection, ranging
from mild to severe infections. For this reason, Antibiotic use is strongly considered for
moderate to severe wounds in veterinary patients. However, the antibiotic therapy is considered
controversial in human patients with dog-inflicted bite wounds (Collaham M, 1982)
The case presented in this report is about a successful surgical operation on a bitch that had a
dog-inflicted bite wound






2


2. CASE REPORT
2.1 CASE HISTORY
A 6 years old female Maltese dog weighing 12kg, with the name Bella, belonging to Mr Khalid
was presented to the University of Makerere Small Animal Clinic on 02
nd
October 2013. The
owner complained that the bitch had a gradually increasing swelling on her right neck, which
arose after it was bitten by another dog 2 weeks ago. Initial aspirations of the swelling and
Antibiotic treatment made were unsuccessful.
2.2 ANIMAL BIO-DATA
Species Dog
Breed Maltese
Age 6 years
Weight 12kg
Owner


2.3 PHYSICAL EXAMINATION
The bitch had gross swelling on the neck region between the cranial aspect of the right shoulder
to the angle of the mandible. Palpation revealed a very large, fluctuant, non-painful fluid filled
mass.
Physiological parameters (temperature, heart and respiratory rates) were within normal ranges.
Aspiration of the swelling with a needle under aseptic conditions revealed the presence of blood-
tinged serous (sero-sanguineous) fluid. Surgery was immediately undertaken to drain the
swelling, as previous Antibiotic treatment was unsuccessful.

3


Fig1. A gross swelling on the neck, just before the surgical operation was done













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3. THE SURGICAL PROCEDURE
3.1 PRE-OPERATIVE MANAGEMENT AND PRE-MEDICATION
The patient was sedated using 2% Xylazine Hydrochloride 0.5ml intramuscularly, and the entire
area around the swelling was prepared for aseptic surgery by shaving, cleaning with water and
soap and then surgical scrub solution was applied on the skin, using Povidone iodine.
3.2 THE SURGICAL OPERATION
The patient was put on left lateral recumbency, and restrained manually. The swelling was
surgically explored by making small longitudinal skin incision at the bottom with the help of
surgical blade. By applying pressure on the swelling, a blood-tinged serous (sero-sanguineous)
fluid, which accumulated in a cavity between the skin and the underlying subcutaneous
structures, was then drained out into a metal bowl.

Fig 2. Wound is opened and fluid drained out Fig 3. Fluid drained into metal bowl
The cavity was thoroughly disinfected with Hydrogen peroxide, and then lavage was done with a
sterile saline solution, using 50-ml syringe with 18 g needle, to facilitate removal of bacteria,
dead tissues and any other possible debris from the wound
The cavity was then packed with sterile gauze to avoid formation of pockets accumulated with
fluid and bacteria, which would further contribute the development of severe infections. Small
edge of the gauze was left extending beyond the wound opening, so that it makes pathway for the
infection to drain out of the cavity. Finally, the wound was left open to heal.
5


Fig 4. Packing the wound cavity with a sterile gauze















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4. THE POST-OPERATIVE CARE
The post-operative therapy consisted antibiotics and pain management therapies. 1ml of
PenStrep (an antibiotic) was daily administered intramuscularly for 7 days to assist in the healing
process.
Dexamethasone tablets were administered through the oral route at 1mg/day for 7 days to
manage the inflammatory process thus alleviating pain.
Hydrogen peroxide was applied on the wound margins 3 days post-operatively, and on the 10
th

day of post-operation, the wound got healed completely.
















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5. DISCUSSION
In one study, the majority of victims in a set of dogs (comprising Toy, small, medium, large and
giant breeds) that were admitted to small animal clinic due to dog bite wounds belonged to small
and large breeds; fewer toy, medium and giant breed dogs were recorded. The study further
followed the location of bites in the body, and the most common areas of injury, in order of
occurrence, were the head, thorax, neck, limbs and abdomen (Baranyiova E. et al, 2002). The
findings noted in this literature are in line with the case presented here; as far as the most
common victims and body locations are concerned.
The incidence of bite wounds was found to be significantly higher in females than in males (i.e.
71% vs 29%) (Shamir et al, 2002). In this very study, the highest incidence of bite wounds
ranged between ages 2-7 years, with the number of bitten dogs declining with advancing age. In
this case, the age of the patient happens within that range, and thus it agrees with the findings by
Shamir et al.
The wound management approach applied in this case involved clipping and cleansing of the
site, surgical exploration of the swelling, lavage, packing, establishment of drainage and
antibiotic therapy. This corresponds to the present literature about bite wound management
(Armelle DL, 2013). However, this was done only after an initial antibiotic therapy administered
for two weeks was unsuccessful.
Following clipping and aseptic cleansing, surgical exploration of the swelling was done. The
skin may still appear relatively intact as it tends to be more elastic and moveable than the
underlying structures, thus hiding more significant underlying damage. For this reason, surgical
exploration was considered more appealing.
Antibiotic administration as a prophylactic treatment for bite wounds in humans have been a
subject of controversies. One study suggested that dog bites in humans do not need antibiotics, as
each time which passes following the inoculation of bacteria theoretically limits the effectiveness
of Prophylactic Antibiotics (Callaham M, 1982).
In contrast to humans, antibiotic use should be strongly considered for bite wounds in veterinary
patients. This is because, veterinary patients are more likely to have their wounds become
contaminated with the attackers oral bacteria, victims endogenous skin/hair bacteria and soil
8

organisms. However; an initial antibiotic therapy was unsuccessful in this patient; therefore
surgical operation plus antibiotic was considered later on.




















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6. RECOMMENDATION
The good outcome of the systemic therapy with PenStep in this case of bite wound indicates that
it could be applied when infection is suspected.
Bacterial isolation from the wound, as well as antibiotic sensitivity should be carried out before
any antibiotic therapy is subscribed for dog-bite wounds as multiple bacterial species including
gram positive, gram negatives and anaerobic pathogens are frequently isolated from bite wounds.


















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REFERENCE
Baranyiova E, Holub A, Martinikova M, Necas A, Zatloukal J: Epidemiology of intraspecies
Bite Wounds in Dogs in the Czech Republic. ACTA VET.BRNO 2003, 72:55-62
Armelle D. Laforcade: Bite wounds and other penetrating traumas. Western veterinary
conference, 2013
Callaham M: Human and animal bites. Topics Emerg Med, 4:1-15, 1982
Goldstein EJC, Richwald GA: Human and animal bite wounds. Am Fam Physician, 36: 101-109,
1987
Kolata RJ, Kraut NH, Johnston DE: Patterns of trauma in urban dogs and cats; a study of 1000
cases. Journal of the American Veterinary Medical Association, 1974, 164(5)
Shamir MH, Leisner S, Kelement E, Gonen E, Johnston DE: Dog bite wounds in dogs and cats:
a retrospective study of 196 cases. J Vet Sci A49: 107-112