A Case Study of Delayed Primary Suturing in Facial Injuries Following Animal Bites

Aims: To evaluate the role of delayed primary suturing in prevention of sepsis and achieving better cosmetic appearance in animal bite injuries over the head and neck areas.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Otorhinolaryngology at Govt. Medical College, Nanded, Maharasthra, (India) from a period of Jan 2009 to Dec 2013.

Methodology: A prospective observational study of 70 cases of patients presented to us in the form of injury to head and neck area by animal bites. In all patients we followed the standard norm for delayed primary closure in form of:

• Thorough wound toileting
• Equine Rabies Immunoglobulin at the site of wound in all patients
• Anti-Rabies vaccination
• Daily dressing
• Delayed primary suturing after 10 days

All patients were routinely followed up and assessed for wound sepsis, cosmesis and function.

Results: Among the animal bites, dog bite injuries were found to be most common facial injuries followed by swine and cat. In our study group of 70 patients which was dominated by males from second decade onwards showed a faint line of demarcation in sex distribution in children. Cosmetic outcome on comparing our study of delayed primary closure with Paschos NK et al. study healing by secondary intention, delayed primary suturing exhibited significantly better result with the mean score of (1.50) for VSS compared to healing by secondary intention group with mean score of (3.05) for VSS was recorded (p= 0.000) (95% CI 0.1516-0.1494).

Conclusion: Delayed primary closure exhibited improved cosmetic appearance when compared with healing by secondary intention.