Dogbites and Reconstruction 2
Subj: Re: dog bites
My name is R... , My wife was bitten by a german shepperd
in oct 5. The damage was appox 1to 11/4 inch of the center of the
upper lip to the very bottom of the nose. S had to have a graft from
her arm to her upper lip. the muscle tissue was there ,but that was
all. She is on her third surgery and most of the damage has been repaired
(considering) the damage . IT seems to look like a cleftlip repair
since the cupids bow is gone. Most of the work was done buy removing
all of the damaged tissue and using the inner part of the lip(flap)
and making the repair. My Question is How many things can still be
done ? I have heard of sanding or fine repairs of the scar tissue.
Is that what she has to ask about? We never realized that there are
so many procedures. The Doctor we are using is Dr. ... from Springfield
,Il.
Thank you
R/Taylorville, IL
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
You are correct, there are many possibilities in reconstructive surgery.
I wish I was good enough to make an evaluation and recommendation
on treatment from reading an Email message. The truth however is that
a doctor needs to see, feel and watch a scar move. Sometimes there
are no further options, reconstructive surgery can only offer so much.
That is why I put up my Dog Bite Prevention Page on the web.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: dogbite
Dear Dr, My name is H. 17 mths ago, I was attacked by two
cattles dogs. the attack was very vicious, the result was, as you
can see in my pic. I am believed to have not only suffered the lacerations
and mental terror, but I have sensory nerve damage to the lower leg,
and has exascerbated a spinal injury. My question is, I dont know
anything of the sensory nerve situation, do they mend??? Please, thankyou
for your interesting site.
thankyou, yours faithfully H
Bathurst Australia
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
No pictures came with your message.
Nerve regeneration depends on many factors
degree of injury to the nerve
type of repair if done
where the injury is in the body (level of injury)
age of the patient
patient's ability to heal
Some nerve injuries are so small that they come back very quickly.
This is like hitting the "funny bone" at the elbow. Other
nerve injuries are so severe that recovery is not possible. You pose
good questions for your treating physicians more aware of your condition.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: dog bites
do you have any information about the tendency of retired
racing greyhounds that are adopted by families to bite? i am considering
adopting one and would appreciate any information that is available.
thank you
d
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
No idea.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: dog bite , my grandchild, age 3, bite my the family dog.
dear doctor, i would like to know about a facial wound,
my grandchild family dog bite the left side of the childs face. i
look at him, and wanted to cry, it broke my heart, the dr. did plastic
surgery , what type of scars will this child have for life, both mental
& physical . what really was upsetting the dr. after surgery came
out and said, told the parents that he has just perform 10,000 dollars
worth of surgery. no concern for the well being of the 3 year old
or the parents.
thank you , a concern grandparent
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
Dog bites can be very hard emotionally on the patient, the family,
AND the people who take care of them. Unfortunately your doctor is
the best one to describe the extent of potential scarring. The body
heals by making a scar. We as plastic surgeons try to help the healing
to limit the disfiguring aspect of the scars. I cannot support the
statement about the cost during the initial after surgery discussion
and wonder if the doctor doing the plastic surgery was a board certified
Plastic Surgeon (by the American Board of Plastic Surgery) or someone
else. If not, then you might need someone else who has examined the
patient to advise you about the scars. I try to design my initial
reconstruction to limit the need for scar revisions. After my repairs
I need to wait usually around 4 - 6 months to see if a well healing
wound would need revisions. During the healing I try to influence
the wound to minimize scars. This advice depends on an examination
and evaluation.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: dogbites
Greetings Dr. Bermant:
Your web site is very interesting. Would you happen to have any color
brochures or photos of children with dog bite injuries? I am currently
trying to get something done about a dog roaming freely barking and
being aggressive. As you know most people are reluctant to get involved.
If I could show them what may happen I might be able to get some support.
I know the danger because my brother was a dog bit victim in his youth.
If there is anything you can send me I would greatly appreciate it.
Thanks.
Please send to:
K
Friendswood, TX
Thanks again.
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
The brochure we have is designed to minimize dog injuries and not
inflame the dog loving public and does not show graphic injuries these
bites can create. That is why I also put the information onto my website.
The website can be accessed by all and the graphical pages ignored
or viewed. These images on the website however may not be downloaded
nor reprinted. The text of the brochure is also viewable on the site.
The plain brochures are available from my office, send a self addressed
envelope with US postage for first class mail to receive a free brochure.
Larger quantities are available.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: Dogbite Nose
Dear Dr. Bermant:
I received a dog bite to the tip of my nose which resulted in a small
piece of flesh being completely removed from my nose. The tissue removed
is approximately 50% the size of a dime and extends into the Dermis,
thus not simply a superficial loss. Before the small piece was sewn
back in place, the wound looked like your basic bad gash with uneven
edges. I also received Antibiotics and a Tetanus shot as well.
My question lies in what the best possible result could be as far
as what the injury will look like after treatment. If the sewn chunk
of skin "takes" and heals I'm sure I will have some sort
of scar. If the repair dies (Necrosis) and the chunk must be removed
and the wound left to heal on it's own I'll definitely need some plastic
repair as the depth of the wound cannot be made up by simple healing.
There was no structural damage to the underlying cartilage and I
am a healthy white 32 yr. old male with a medium skin tone. What are
your suggestions as to what type of graft might be best and what type
of scarring I can expect to have to work towards repairing, depending
of course on whether or not the piece of tissue sewn back in place
is successful or not. This info will better prepare me for my upcoming
discussions with health professionals.
Thank you for your time and any advice or suggestions.
Sincerely,
B
(I know, I know - what kind of a bonehead gets the tip of his nose
bitten off by a dog. Bad Luck. But I want my nose to look good again!)
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
You are not alone, I have had treat quite a few nasal tissue losses
from dog bites. I just did another one this Monday where the tip defect
was larger than a dime and down to the cartilage.
Sometime in partial defects, healing with wound care alone produces
a nice scar. In other defects, surgery is a better option. Secondary
scar revision are sometimes another option. Each wound and defect
needs to be individually examined and evaluated for treatment recommendations.
I prefer to see such problems shortly after the injury so the best
course of treatment can be started.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Subj: Re: dog bites
Dr. Bermant,
Thanks so much for you quick response. I've been sitting here searching
the net. I've been going through the archives at the CDC and attempting
to download some of the articles they have listed in Pediatrics. For
some reason they become unreable. I'll trot over to Harvard Med School
library this weekend and pull them.
I'd been searching since I wanted the most up to date facts I could
find. I will gladly list your web site in my article. I shall be submitting
it for publication to Dog Fancy, Dog World and Dog and Kennel magazines.
Thanks again.
C
go to the greatful med or pubmed sites on the NLM site. That is serious
medical searching engines doctors use. But the abstracts will be filled
with medical jargon. If you have difficulty understanding any, please
let me know.
Michael Bermant, MD
Subj: Re: dog bites-medical costs associated with
I am director of a large animal control dept and a veterinarian
involved in bite investigation for the health department. In taking
action to deal with dangerous dogs we have considered requiring ins.,bonds,etc.to
help victims recoup costs/damage from dog owners. The commission has
asked us about the associated costs of the treatment from bites ;
as you and I know I could probably get a master's degree if I had
time to do the study that would give a local cost- lacking the time
and given my deadline to report back ,I am in search of any data available
nationally. I have found a study that gives the "clean and flush"
costs in ER's =$274. This leaves out suturing ,treating infections,
hospitilazation and the followup costs of plastic surgery. Do you
have any info regarding these costs or any typical costs per procedure
that would be helpful? I have national cost estimates for all bites
but the commission was asking an average or range for the individual
treatments. Thanks for any info and like your info on line-KDM
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
An animal bite can need many different types of treatment depending
on severity. A scratch or minimal puncture wound may only need the
services of the emergency room doctor and would be covered under the
global fee for evaluation. More significant injuries may require a
simple, layer, complex, graft or flap reconstruction. Some defects
require multiple complex multi-hour reconstructive operations in the
operating room. Each repair has different prices according to size
and location on the body. Such prices can range from several hundred
dollars to many tens of thousands of dollars. Complications of dog
bites can increase the cost when infection requires multiple additional
debridements or secondary procedures. There is a sad trend for more
to be taken on by untrained doctors doing more complex injuries than
for which they are trained. The increased cost of the complications
or those seeking secondary revisions needs to be taken into account.
HMO's and insurance companies also pressure unrealistic pricing so
far below reasonable fees that many of my colleagues are withdrawing
because of unconsciously low reimbursement. Some of these companies
have refused to cover the cost of secondary revisions on horribly
disfigured scars considering such repairs "cosmetic" in
nature and not covered by that plan. I do not know how long the American
public will put up with the deteriorating system. So the cost to the
patient depends on many factors. Real costs can be so perverted by
who is organizing the numbers that there are no real way of coming
up with a realistic answer.
I hope this information proves of value.
Michael Bermant, MD
Board Certified
American Board of Plastic Surgery
Subj: Re: Dog Bite Injury
Dr. Bermant:
I am writing to you after finding your web site regarding dog bite
victims.
I am a 29 year old female. I live in Havre, Montana, where I own
and operate a Dog Grooming Salon as well as a Pet Resort.
On Christmas Eve, just two weeks ago, I checked one of my yearly
out-of-state guests in to the resort for his annual 4 day Christmas
vacation, while his owners spent Christmas with their family here
in Havre.
"J" was a 9 year-old Rottweiller (probably 90 pounds or
so) from Seattle, who had previously spent 3 such vacations with me,
and was a welcomed guest. He had never shown any aggression toward
me nor any of my staff in the past.
I greeted "J" as he entered our lobby, and he seemed quite
happy to see me again. I visited with his owners while I sat on the
floor face to face with him. His owners commented on his recognizing
me, and they relayed to me that they would rather drive him out to
Montana (a 1200 mile trek) instead of boarding him in Seattle, as
seemed much happier going home from my resort. I was of course thrilled,
and was glad to again see "J" who stood in front of me during
this 20 minute chat and licked my face as I petted him, and wagged
what little tail he had. He showed absolutely no sign of aggression
toward me at this time.His owners then put "J" in his Presidential
Suite, an indoor 5' by 8' chain link run in the kennel room and left.
After owning a boarding kennel for 6 years, and almost 20 years as
a dog groomer, I consider myself to be fairly well-versed in the area
of dog handling and behavior. But I had no idea nor warning of what
was about to happen next.
I decided to fill J's food dish since he was probably hungry after
the long trip. I opened the kennel door, verbally greeted J who was
standing in the very back of the run. I fearlessly stepped into the
run with only one foot, and filled the food dish. After doing this
one thing thousands of times, I am aware that some dogs may be territorial
over their food, and these such dogs will approach you head on and
get between the feeder and their dish and show some type of aggression.
However, J did not do that.
As I filled the dish, I could see J out of the corner of my eye moving
very slowly up behind me, sneaking up on me. I was at this point half
bent over, I slowly pivoted my upper body to the left to see him more
clearly. J was approximately two feet away from me at this time, and
was standing perfectly still. He waited for me to turn, and as I glanced
at him, he went for my throat.
His upper teeth went all the way into the fleshy part of my chin
very deep, and his lower canine tooth went up into my lymph glands
under my jaw bone. He then began to shake me back and forth. I knew
at that point that I was badly injured as I could feel the blood poaring
own my chest. I knew from all the classes and instruction that I've
had in the past that no matter what, not to pull away as the flesh
will then tear and be more difficult to repair. So I did the very
last thing I wanted to do: I pushed my face into J's, forcing him
to let me loose. I then pulled myself away, but not quickly enough.
J's second strike caught me in the neck, locking his teeth around
my carotid artery. It was at this point that I realized my life may
be ending here, right here in my dog kennel, at the mercy of this
dog whom I knew and loved. Everything around me then went dark, and
as they say my life truly did flash before my eyes; How would my fiance
react when he found me here this way? How would my family react to
my death on Christmas Eve... It was the most horrible moment of my
entire life. It was then that my self-preservation instinct kicked
in: I reached up, grabbed a hold of his jaws, and effortlessly unhinged
them from my throat, and ran for my life.
J did not chase me, and I was able to run into the lobby which is
attached to the kennel, and shut the steel door behind me. I ran to
a mirror to see how badly torn my neck was, and if I would have enough
time to make it to the hospital. While I was relieved to see only
the deep puncture wounds in my neck, my chin was hanging open and
badly bleeding.
My fiance rushed me to the local hospital, only after I had contacted
the dog's owners and they returned to pick the dog up. They were,
to say the least, mortified at what he had done.
I had the good fortune of a visiting ER doctor from another city,
Dr.X, from Missoula, Montana, who happened to be filling in for the
holiday. After consulting with this doctor and my family, we decided
it would be best to have him close the wounds and seek plastic surgery
down the road. It was 4:00 p.m. on Christmas Eve, and the closest
plastic surgeon was 3 hours away in another town 100 miles away, and
it was blizzarding.
Dr.... took 6 painstaking hours to carefully put my face and neck
back together. My chin received 17 external stitches, and well as
severy internal stitches to anchor the wound, of which I lost count.
He then closed the 3 puncture wounds on my neck with 4 stitches each.
He restitched all three at least once for the best asthetic effect.
He was quite concerned with the deepest wound, which was made by a
lower canine tooth which went around the back of the artery; as it
turned out, it did not nick the artery, thank goodness. I was given
an antibiotic shot, as well as 875 mg of Augmentin to take orally,
and sent home.
I bathed the suture lines every two hours during the night with a
Q-tip and Hydrogen Peroxide, and followed by Neo-Sporin. The next
day, Christmas Day, I went back to the ER where Dr. X admitted to
the hospital, where I was given Unisyn through an IV for 5 long days.
On the fifth day, my regular doctor, Michael Y, removed the sutures,
at which point he inserted a needle through one of the suture holes
to check for infection. He did not find a pocket of infection in the
chin wound, however the wound over the artery had become infected
and he drained it manually by applying pressure to my neck. He then
sent me home.
I returned to the clinic 2 hours later as the wound on my chin began
to drain through the needle mark. Dr. Y checked the wound and told
my to hot pack it with a dry hot pack to see if it would completely
drain, which I did. It continued to drain until the next day when
the doctor rechecked it. It felt completely better, however the wounds
on my neck continued to worsen. That very next day was New Year's
Eve, and Dr. Y once again looked at my progress: the chin wound was
significantly improving, but the neck wounds had gotten worse. He
then referred me to an Ear Nose and Throat Specialist, who is also
a Plastic Surgeon, Dr. Z in Great Falls, Montana. I was to see him
New Year's Day.
That evening, upon urging from Dr. Y, I hot packed the wounds on
my neck with wet hot packs, and was finally able to drain my neck
through the wound closest to the artery. It drained continuously for
over and hour, and afterward I looked like a different person. The
swelling was greatly diminished and while it was quite sore, it felt
much, much better.
I then saw Dr. Z for the first time on the 2nd of January in Great
Falls. He was very impressed with my condition after draining the
neck wounds, and opted to continue me on the the Augementin for another
10 day period. He showed me how to open the neck wound up with a Q-tip
wet with hydrogen peroxide in order to open up what used to be the
pus pocket so it would heal from the inside out. He instructed me
to do this daily, which I have done, until last night when that same
neck wound (near the artery) seemed to be worse. It would not drain
very much, and today it has been extremely sore.
I just hooked up to the internet today, with my main objective to
find any kind of information relating to dog bites. I was compelled
to contact you after viewing the before and after pictures of your
patients. I would appreciate any kind of information you may have
for me, on follow-up surgery, infection control during the healing
process, wound care in the interum, as well as any known support groups.
Tomorrow will be the 2 week mark after my attack; it seems as though
my whole life has completely changed. I am getting married next January,
and hope to have this entire ordeal well behind me, hopefully along
with most of my scars.
Thank you for your time. I look forward to hearing from you!
Sincerely,
S
Havre, MT
This should not be construed as medical advice. I am a Board Certified
Plastic Surgeon.
Bite wounds can be a real problem to treat. I prefer to do my plastic
surgery at the beginning. Good aggressive wound care initially is,
in my opinion the best chance for minimal complications and scars.
Even in the best of hands dog bite wounds DO get infected. When less
experienced doctors try repairs on extensive injuries, infections
seem to be more common. Perhaps it is a more radical approach that
I can take with my original debridement and reconstruction with all
the possible choices available to a reconstructive surgeon.
Secondary healing after complications like infections tend to lead
to scars that are more visible and can be a problem. Getting a wound
that was infected close, can take quite a while depending on the problem
and who is directing the care. Scar revisions are often best deferred
until the original wounds have matured (when the wounds were optimized).
In some cases I suggest earlier surgery, especially when I feel the
present problem will not benefit from waiting that time. Each wound
and problem needs to be individually assessed and evaluated.
I hope this information proves of some use. If my office can be of
further assistance, please let us know. We can be reached at: (804)
748-7737. My staff and I try to ensure the comfort of our out of town
guests during their consultations and procedures.
Michael Bermant, MD
Dogbite
Prevention
Dog bites of Lip and Reconstruction Photographs (graphic)
Dog
bite Injury Face Repair / Reconstruction Photos (graphic)
Camel Bite Reconstruction
Find books about dog bite prevention from Barnes
and Noble
Bite Injuries Reconstructive Surgery bulletin boards
Bulletin
Board for Patient's Questions and Answers
Hand 
