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Treating Bite Wounds Conservatively vs Surgically

Clinician's Brief (Capsule)

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Suggested management of thoracic bite trauma is controversial, with recommendations ranging from conservative treatment to exploratory thoracic surgery for all cases. The purpose of this retrospective study was to report a case series of dogs and cats with thoracic bite trauma; to describe associated clinical findings, management, and outcomes; and to evaluate potential risk factors for mortality. Sixty-two cases (54 dogs, 8 cats) with a total of 65 bite wounds were collected. Lesions were categorized by depth of penetration (ie, no open wound, superficial, deep, or penetrating); thoracic radiograph reports were reviewed; and lesion management was classified as nonsurgical, wound exploration, or explorative thoracotomy. Radiographic lesions (eg, lung contusions, rib fractures, pneumothorax, pleural effusion) were present in 77% of dogs and 100% of cats with radiographic reports, including 22% of patients that had been presented with normal respiratory patterns. Overall mortality was 15.4%, with half attributed to owner-elected euthanasia. Neither the number of radiographic lesions nor the presence of respiratory distress correlated with mortality. None of the variables analyzed (eg, wound classification, treatment type) correlated with mortality. 

The authors concluded that in thoracic bite trauma patients, penetrating injuries or the presence of >3 radiographic lesions are prognostic for the need for thoracic exploration. They recommend wound exploration for all other cases, with conversion to thoracotomy if thoracic body wall disruption is detected. 

Commentary 

Results of this study are in agreement with previous retrospective studies1,2 indicating no difference in outcome or prognosis with animals treated conservatively vs surgically. The retrospective nature of this study and relatively low case numbers for each of the stratified variables likely precluded identification of any significant prognostic factors. It is intriguing that a general recommendation was made to perform exploratory thoracotomy in patients with >3 radiographic lesions, as this recommendation does not appear to be supported by the data. It may be more prudent to recommend tailored case management; it is unlikely that a uniform treatment protocol will be appropriate for all patients. Patients with thoracic bite trauma should be thoroughly evaluated for evidence of intrathoracic trauma, as clinical signs and diagnostic imaging may underestimate the degree of injury. Exploration and debridement of all open bite wounds is recommended, with explorative thoracotomy reserved for patients with evidence of flail chest, severe thoracic trauma and/or pneumothorax, or deep penetrating wounds with possible visceral trauma. —Sara A. Colopy, DVM, DACVS 

References

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