Successful Debridement & Suturing of Lower Lip & Bilateral Upper Limbs Following Dog Bite Injury

Chief Complaints

A 45-year-old male patient with a body mass index (BMI) of 21 presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of an alleged history of dog bite injury sustained at home. The patient reported injury to the lower lip and bilateral upper limbs, associated with bleeding from the wound sites. There was no history of loss of consciousness, vomiting, seizures, ear bleeding, or nose bleeding following the incident.

The patient had no known medical illnesses and no history of previous surgical interventions. He had a documented history of allergy to certain medications.

On examination, the patient was conscious, coherent, and cooperative. General examination revealed no pallor, icterus, cyanosis, clubbing, lymphadenopathy, or pedal edema. Vital signs were stable. Local examination showed dog bite injuries over the lower lip and bilateral upper limbs with lacerations and avulsed skin. The wounds showed surrounding soft tissue injury, and hemostasis was maintained. No other external injuries were noted.

Upon admission to PACE Hospitals, following the clinical examination, the Plastic and Reconstructive Surgery and Orthopaedic teams conducted a thorough assessment, including a detailed review of the patient’s medical history and a focused evaluation of his dog bite injuries involving the face and upper limbs.

To confirm the diagnosis and determine the extent of soft tissue injury, the patient underwent detailed clinical and radiological evaluations, including a CT scan of the face. The imaging revealed a linear deep laceration involving the lower lip with minimal adjacent soft tissue edema and a few air foci. Additionally, injuries involving the bilateral upper limbs were noted, consistent with open bite wounds affecting the right upper arm, right elbow, left elbow, and bilateral forearms. No associated facial bone fractures were identified. However, associated mucosal thickening of the paranasal sinuses was noted, suggestive of inflammatory changes.

Based on the confirmed diagnosis, the patient was advised to undergo Dog Bite Treatment in Hyderabad, India, under the care of the Plastic and Reconstructive Surgery team to achieve optimal functional and cosmetic outcomes.

After a thorough evaluation by Dr. Kantamneni Lakshmi (Consultant Plastic Surgeon), and in coordination with cross-consultations from Dr. Snigda Panuganti (Consultant General Physician), and Dr. Raghuram (Consultant Orthopedic Surgeon), a comprehensive assessment was carried out to determine the most appropriate management plan for the patient diagnosed with dog bite injuries involving the lower lip and bilateral upper limbs.

Based on the clinical findings of laceration over the lower lip and multiple open bite wounds involving the right upper arm, right elbow, left elbow, and bilateral forearms, with associated bleeding, soft tissue injury, and contamination, it was determined that wound debridement and primary suturing under general anaesthesia was the most appropriate treatment approach. This decision was made after careful evaluation of the extent of soft tissue damage, risk of infection, including rabies-related complications, need for thorough wound cleansing, prevention of progressive tissue necrosis, and restoration of optimal functional and aesthetic outcomes.

The patient and his family members were counselled regarding the condition, the need for surgery, associated risks and benefits, and the importance of postoperative care, including proper wound care, completion of the anti-rabies vaccination schedule, medication adherence, regular dressing changes, infection monitoring, and follow-ups.

Following the diagnosis, the patient was scheduled to undergo a Debridement and Primary Suturing Procedure in Hyderabad at PACE Hospitals, under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anaesthesia and Patient Preparation: The patient was taken up for surgery under general anaesthesia. After achieving adequate anaesthetic depth, the patient was placed in a supine position. All involved areas were thoroughly cleaned, painted with antiseptic solution, and draped in a sterile manner to maintain aseptic surgical conditions.

• Wound Exploration and Assessment: A detailed intraoperative assessment of all wound sites was performed, including the lower lip and bilateral upper limbs. The extent of tissue damage, contamination, and devitalized tissue was carefully evaluated to plan appropriate debridement and repair.

• Surgical Debridement and Irrigation: All wounds were thoroughly debrided to remove contaminated, non-viable, and devitalized tissue. This was followed by copious saline wash to reduce bacterial load and ensure adequate wound cleansing.

• Layered Wound Closure and Suturing: The split laceration over the lower lip was closed in three layers using absorbable sutures to achieve proper anatomical alignment and optimal cosmetic outcome. Avulsed skin wounds over both upper limbs were also approximated and sutured to ensure secure wound closure and tissue alignment.

• Hemostasis and Post-Procedure Care: Meticulous hemostasis was achieved to control bleeding. Following confirmation of secure wound closure, aseptic dressings were applied over all surgical sites. The procedure was completed uneventfully, and the patient was shifted for postoperative care in stable condition.
  

Postoperatively, the patient was closely monitored for vital signs, pain, and wound condition. Regular aseptic dressings were performed, along with measures to prevent infection and promote optimal wound healing of the lower lip and bilateral upper limb injuries. Supportive care was provided for pain control, hydration, and overall recovery. The postoperative period remained uneventful, and the patient showed steady improvement and was discharged in stable condition.

Upon discharge, the patient was prescribed medications to prevent wound infection, support local wound care, provide gastric protection, relieve pain, and reduce inflammation and edema. Additional support included nutritional supplementation to promote healing and antiseptic oral care to maintain hygiene and aid recovery of the lower lip wound.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increased pain or swelling at the wound sites, wound discharge or bleeding, or signs of infection.

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals after 2 days for dressing. 

This case highlights multiple dog bite injuries involving the lower lip and bilateral upper limbs, managed with timely surgical debridement and layered suturing under general anaesthesia. The postoperative course was uneventful, and the patient was discharged in stable condition with advice for wound care, completion of the rabies vaccination schedule, and follow-up advice.