Management of vascular trauma from dog bites

A. George Akingba, Eric A. Robinson, Andrea L. Jester, Brian M. Rapp, Anthony Tsai, Raghu Motaganahalli, Michael Dalsing, Michael Murphy

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations. Methods From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study. Results Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up. Conclusions Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.

Original languageEnglish
Pages (from-to)1346-1352
Number of pages7
JournalJournal of Vascular Surgery
Volume58
Issue number5
DOIs
StatePublished - Nov 2013

Fingerprint

Bites and Stings
Blood Vessels
Dogs
Wounds and Injuries
Vascular System Injuries
Extremities
Anti-Bacterial Agents
Debridement
Ligation
Pulse
Arteries
Surgical Wound Infection
Soft Tissue Injuries
Radial Artery
Therapeutic Irrigation
Wound Infection
Upper Extremity
Lower Extremity
Veins
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Akingba, A. G., Robinson, E. A., Jester, A. L., Rapp, B. M., Tsai, A., Motaganahalli, R., ... Murphy, M. (2013). Management of vascular trauma from dog bites. Journal of Vascular Surgery, 58(5), 1346-1352. https://doi.org/10.1016/j.jvs.2013.05.101

Management of vascular trauma from dog bites. / Akingba, A. George; Robinson, Eric A.; Jester, Andrea L.; Rapp, Brian M.; Tsai, Anthony; Motaganahalli, Raghu; Dalsing, Michael; Murphy, Michael.

In: Journal of Vascular Surgery, Vol. 58, No. 5, 11.2013, p. 1346-1352.

Research output: Contribution to journalArticle

Akingba AG, Robinson EA, Jester AL, Rapp BM, Tsai A, Motaganahalli R et al. Management of vascular trauma from dog bites. Journal of Vascular Surgery. 2013 Nov;58(5):1346-1352. https://doi.org/10.1016/j.jvs.2013.05.101
Akingba, A. George ; Robinson, Eric A. ; Jester, Andrea L. ; Rapp, Brian M. ; Tsai, Anthony ; Motaganahalli, Raghu ; Dalsing, Michael ; Murphy, Michael. / Management of vascular trauma from dog bites. In: Journal of Vascular Surgery. 2013 ; Vol. 58, No. 5. pp. 1346-1352.
@article{f479214f7fd841ebbbbfcc5148bbeb9f,
title = "Management of vascular trauma from dog bites",
abstract = "Background Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations. Methods From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4{\%}) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study. Results Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85{\%}) had upper extremity injuries; three patients had lower extremity injuries (15{\%}). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45{\%}), followed by the radial artery (n = 4/20; 20{\%}). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50{\%}), bone (n = 1/20; 5{\%}), nerve (n = 1/20; 5{\%}), and combinations of the three (n = 5/20; 25{\%}). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20{\%}) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100{\%}) were viable at discharge and at 1-year follow-up. Conclusions Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.",
author = "Akingba, {A. George} and Robinson, {Eric A.} and Jester, {Andrea L.} and Rapp, {Brian M.} and Anthony Tsai and Raghu Motaganahalli and Michael Dalsing and Michael Murphy",
year = "2013",
month = "11",
doi = "10.1016/j.jvs.2013.05.101",
language = "English",
volume = "58",
pages = "1346--1352",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Management of vascular trauma from dog bites

AU - Akingba, A. George

AU - Robinson, Eric A.

AU - Jester, Andrea L.

AU - Rapp, Brian M.

AU - Tsai, Anthony

AU - Motaganahalli, Raghu

AU - Dalsing, Michael

AU - Murphy, Michael

PY - 2013/11

Y1 - 2013/11

N2 - Background Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations. Methods From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study. Results Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up. Conclusions Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.

AB - Background Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations. Methods From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study. Results Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up. Conclusions Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.

UR - http://www.scopus.com/inward/record.url?scp=84886582323&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886582323&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2013.05.101

DO - 10.1016/j.jvs.2013.05.101

M3 - Article

C2 - 23891489

AN - SCOPUS:84886582323

VL - 58

SP - 1346

EP - 1352

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 5

ER -