# stitching a puncture versus leaving it open



## rick smith (Dec 31, 2010)

always been curious about treating dog bites.....should they be stitched as most ER treatments would do, or left open to heal ?

i'm talking about getting tagged on an arm or leg where there is a definite 1/4 inch or so deep puncture and some meat loss that will not close up on its own, as in pencil width....i've had a couple that weren't stitched and took a long time to fill in and had one that i got stitched and healed much faster.....the not stitched ones required washing and flushing a few times a day (pita), but never got infected

Q is whether there is a right or wrong way to treat canine punctures as a general rule or is the ER always stitch em up philosophy the best. never heard it discussed much but did "read" a couple years back on the leerburg forum that most thought they should be left open to heal

,,,,anyone have any bad probs with infections ?
....suturing for cosmetic effects just to reduced a scar is not that important to me


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## David Frost (Mar 29, 2006)

When I was in the military, punctures were not sutured. They were allowed to heal from the bottom up. From personal experience, a few of the deeper punctures were packed with a thin strip of gauze and changed daily. On one bite, where I had a deep lacertion, along with a broken radius, they didn't suture it. They had my arm in a half-cast. They couldn't put a full cast on for fear of infection and swelling. Not a memorable experience. 

DFrost


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## Ricardo Ashton (Jun 3, 2010)

Sutured punctures heal faster because the tissues rejoin themselves easier & faster rather than having to grow new tissue to fill in the hole. Though it would be easier to get an infection from a sutured puncture if it isn't properly cleaned. I usually leave my bites open to the air and they still heal pretty fast. So I guess there really isn't a right or wrong way, just different people use either method as far as they were taught.


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## Joby Becker (Dec 13, 2009)

The treatment varies. some stitch some don't.

It really depends on the situation and conditions of the hole (bite).

If one goes to the doctor immediately and depending on if it was done under somewhat clean conditions, some will stitch.

If time passes, and it was a dirty environment, some won't stitch.

Deliberately vague I know, some may want to stitch anyway...

The important part is it will close up on its own...like you said though takes longer..

I had a pretty bad bite on my hand, in the meat of the thumb, almost 2 inches long and split open about an inch...(leaving nothing inside a mystery)...on the palm, I went in, but it was too late to stitch up, and I continued working dogs for an hour or so after the incident, so they cleaned it best they could..

I went in because I thought I could not move my thumb, the muscle was pretty tore up, I went in too late, over 12 hours later.

The protocol was to leave it open, and soak it in hot water, a few times a day to let it bleed and flush itself out. Took a while to heal....lost some fat tissue (which doesnt seem to come back)

I also had a pretty good one on my thigh, about the size of a nickel.. could see down in there...That one took a long time to heal as well, no stitches...and there is still a soft spot there, like not much is behind there. That was not stitched either.

That one did get some infection, because I worked over 30 dogs at an event, in the suit 3-4 days later in a dirty barn, and did not notice the bandage fell off midway.


I have had 2 bouts of cellulitous, that is a concern for some.

I have stitches also, and had to have one drained that I do not think was cleaned...I should have just told them I did not want stitches, would have been easier.

Fingers I would think would get stitched...

If I was to get bitten tomorrow I doubt I would want stitches, unless they could really convince me that it was necessary...

Antibiotics are your friend...stitches may not be.


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## rick smith (Dec 31, 2010)

appreciate the good info
sure i will get bit again; hope this doesn't jinx me 

i usually just flush with a lot of hydrogen peroxide (until it stops fizzing) and water and use a surgical liquid scrub i got a large supply of and then just stuff it with neosporin.....i only drip alcohol over it if i'm feeling tuff that day 
...really don't know if there are better antibiotics avail OTC .... over here the antibiotics the Ja pharmacies sell is all prescription ..... they're not big on "diy" treatments 

and cross my fingers the dog hadn't been having a butt licking session before we started :-(


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## Joby Becker (Dec 13, 2009)

rick smith said:


> appreciate the good info
> sure i will get bit again; hope this doesn't jinx me
> 
> i usually just flush with a lot of hydrogen peroxide (until it stops fizzing) and water and use a surgical liquid scrub i got a large supply of and then just stuff it with neosporin.....i only drip alcohol over it if i'm feeling tuff that day
> ...


I am sure you do not want to flush out a deep puncture with hydrogen peroxide...the ones I had would be like pouring it in a hole..in fact I did do that, and was told NOT to do that....it just seeps into everything inside...I am pretty sure peroxide is not for internal use..at least that is what I was told. I remember pouring a good little bit into my thigh, and feeling the inside bottom of my leg getting cold on the inside as it traveled down in there.


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## Maren Bell Jones (Jun 7, 2006)

rick smith said:


> always been curious about treating dog bites.....should they be stitched as most ER treatments would do, or left open to heal ?
> 
> i'm talking about getting tagged on an arm or leg where there is a definite 1/4 inch or so deep puncture and some meat loss that will not close up on its own, as in pencil width....i've had a couple that weren't stitched and took a long time to fill in and had one that i got stitched and healed much faster.....the not stitched ones required washing and flushing a few times a day (pita), but never got infected
> 
> ...


I'm not an MD, but ER docs should not be suturing them up (if you are honestly reporting them as a dog bite, which I know not everyone does... :-\"). A puncture wound innoculates all the lovely bacteria in a dog's mouth like Pasteurella just like an injection and closing that up is not good. I was taught not to suture up dog fight wounds, at least not immediately. What's below the surface is often much worse than what it looks like from outside. I know it's a point of honor with decoys not go in, but you really should. 

A friend of mine broke up a dog fight between her dogs and got bit on the base of her thumb. It didn't look so bad at first, so she didn't go in. She ended up almost loosing her thumb and needing to go on several rounds of antibiotics to clear the infection. Cat bites are worse as their teeth are sharper. Had one cat bite me during an exam and it took over a month to heal.


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## ann schnerre (Aug 24, 2006)

i was always taught that punctures should be left open. suturing the top of the wound just closes it and then you have an abcess to deal with. at best.

@maren--i was bitten by a cat in my thumb, and ended up having IV anibiotics as i got blood poisoning within 4 hours. my doc told me if it got up to my shoulder, i'd best get to the ER. it got up to the top of my bicep--and the kids and i went to the state fair anyway. i just kept an eye on the progression while we were there. 

cat bites are nothing to play around with....


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## maggie fraser (May 30, 2008)

Wouldn't it be sensible to insert some form of drain when closing up some puncture wound whether human or animal ?

Pucture wounds that I have dealt with in the past, dogs or horses would be to get them regular trips into the sea, ie. salt water. If the hole is big enough, you can get proud flesh, ugly stuff that grows to bind, but does bind the tissue and keeps infection out.

If we're talking human, I'd probably want it closed with a drain...and a course of anti biotics once thoroughly cleaned.


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## Maren Bell Jones (Jun 7, 2006)

Can't speak for humans, but on dogs, cats, etc, you can leave a laceration open to drain for a few days and then suture it (called secondary closure) if you are managing it properly. It's not going to be as pretty as done in the first six hours, but it works okay. If you can't do a graft for a difficult to close wound, sometimes you have to let it granulate in or do a tie over bandage before you can suture to eliminate dead space. Placing drains has their issues too and usually should be done in very particular circumstances.


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## maggie fraser (May 30, 2008)

Maren Bell Jones said:


> Can't speak for humans, but on dogs, cats, etc, you can leave a laceration open to drain for a few days and then suture it (called secondary closure) if you are managing it properly. It's not going to be as pretty as done in the first six hours, but it works okay. If you can't do a graft for a difficult to close wound, sometimes you have to let it granulate in or do a tie over bandage before you can suture to eliminate dead space. Placing drains has their issues too and usually should be done in very particular circumstances.


I've had a a drain inserted before, reckon it was the best thing that ever happened LOL No proud flesh neither :-D.


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## Kadi Thingvall (Jan 22, 2007)

rick smith said:


> always been curious about treating dog bites.....should they be stitched as most ER treatments would do, or left open to heal ?


I think we've gone to different ERs and doctors. 90% of the ones I've dealt with will not stitch a puncture wound from a dog, for various reasons already mentioned here. 1 was willing to, but not right after the bite, he said come back in 2 days. He wanted to see how much draining it was doing, as there was a lot of damage done around the bite from the pressure. When he saw it 2 days later he said it was still draining way to much to stitch up, and I'd have to see a plastic surgeon after it healed if I wanted the scar tissue removed. Never did, still have a big "lump" on the inside of my knee from it. 

The only one I've seen stitched that I can remember was reported as a dog bite to the ER, but actually looked more like a knife wound, the dogs canine caught the person in the arm and sliced it open, but they didn't actually bite down so there was no other wounds, no bruising, just the one slice. They did stitch that one up, although they did a crappy job of it and the person still has a pretty good sized scar on their arm.


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## leslie cassian (Jun 3, 2007)

Kadi Thingvall said:


> The only one I've seen stitched that I can remember was reported as a dog bite to the ER, but actually looked more like a knife wound, the dogs canine caught the person in the arm and sliced it open, but they didn't actually bite down so there was no other wounds, no bruising, just the one slice. They did stitch that one up, although they did a crappy job of it and the person still has a pretty good sized scar on their arm.


That sounds like what happened to me. When I got bit/slashed, it didn't hurt much and I just covered it and went to bed. I was already taking antibiotics for a cat bite, so had that covered and didn't want to deal with the fallout from reporting a dog bite. In the morning I looked at it again and it looked much worse. So off to emerg. to be told I was on the edge of too late to stitch, but it did need to be stitched. Three loose stitches and I still have an ugly scar.


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## vicki dickey (Jul 5, 2011)

I almost had to have my foot amputated due to a cat bite. Ended up in the hospital for a couple of days with that bite. I believe a cat bite is consider worse than a dog bite. I was a dog groomer and was known to work with dogs with an attitude. Got bit a lot-never stitched any of them. One bite did sever a tendon in my finger. That finger isnt the same but it works.
Worse than the cat or dog bite is a recluse spider bite. Right on my cheek, in bed at night and a dozen plastic surgeries later I am looking good. Worse couple years of my life. My dogs were there for me and working with them kept me going.


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## Mo Earle (Mar 1, 2008)

speaking as a trauma/ER RN for people, unfortunately, as I wish now I put my career toward animals only- but anyway - punctures in humans for the majority are not sutured, as they do not want to lock the bacteria in-which could lead to an abscess that would later need to be opened and drained....If however the puncture also has a tear or laceration or a fracture(broken bone) with it- as few sutures possible will be placed- to allow drainage, but help protect the wound- better for it to close by secondary nature-from the inside out- lacerations without punctures, fractures etc... are loosely sutured -again infection being the main worry for closing a wound tightly.


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## Maren Bell Jones (Jun 7, 2006)

You can always come work for me, Mo! :grin: Unfortunately your pay as an RN is likely to be about the same or better as mine as a DVM. #-o


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## Adam Rawlings (Feb 27, 2009)

I've needed medical attention for two bites (slow learner lol.) both times no stitches. They just gave me antibiotics, a tetanus shot and a funny look.


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## Hans Akerbakk (Jul 1, 2008)

Handler error when showing a scoop ,hand bite thru meaty part of thumb , went to walk in clinic after dogs were worked .
They cleaned the wound and a few stitches but left a part open for drainage healed pretty quick with no problems.


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