Comparative study of primary closure versus non-closure of animal bite injuries in head and neck region: case study of 540 patients


  • Pallavi Saple Department of ENT, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, India
  • Shrinivas S. Chavan Department of ENT, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, India
  • Vitthal Dada Kale Department of ENT, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, India
  • Vinayak Kurle Department of ENT, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, India
  • Abhishek Khond Department of ENT, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, India



Rabies, Wound healing, Primary suturing, Equine rabies immunoglobulin


Background: Rabies is a zoonotic disease caused by lyssavirus and spread through saliva of rabid animal bite. This study was taken to compare primary closure versus non-closure of animal bite wounds.

Methods: This is a prospective randomized study. Patients were divided into 2 groups. Group A consisted of patients with non-closure of wounds and group B with primary closure of wounds. Patients were followed up for wound healing time, infection and cosmesis.  

Results: This study consists of 540 patients (323 males and 217 females). The common age group was paediatric and geriatric age. Most common animal bite was from dogs. The average healing time in non-infected wound in group A versus group B with Lackman’s I and II grading was 10.5±1.25 and 12.5±1.5 days versus 7±1.25 and 8.5±1.5 days respectively. There were 19 cases in group A and 17 cases in group B with infection which subsided with antibiotics in 24 hrs. Cosmesis graded on VSS was better in group B (average 4.03±1.5) as compared to group A (average 2.44±0.185). Only one patient from group A with Lackman’s grade II contacted rabies died 2yrs after the bite.

Conclusions: Animal bite wounds over head and neck were found to be more common in paediatric and geriatric population who are more vulnerable. Infection and spread of rabies virus through these wounds can be prevented by thorough debridement and cleaning whereas primary suturing helps in achieving early wound healing and better cosmesis producing a socially and functionally acceptable scar.



Dutta JK. Human rabies in India: epidemiological features, management and current methods of prevention. Trop Doct. 1999;29:196-201.

Sudarshan MK, Mahendra BJ, Madhusudana SN, Ashwoath Narayana DH, Rahman A, Rao NS, et al. An Epidemiological Study of Animal Bites in India: Results of A WHO Sponsored National Multi-Centric Rabies Survey. J Commun Dis. 2006;38(1):32-9.

Palmer J, Rees M. Dog bites of the face: a fifteen year review. Br J Plast Surg. 1983;36:315–8.

Park K. Epidemiology of Communicable Disease: Rabies in Man: Park's Textbook of Preventive & Social Medicine. 21st edition. Jabalpur, India: Bhanot Publishing House; 2011: 250-257.

Jackson AC. Rabies and other Rabdovirus infection: Harrison’s Principles of Internal Medicine 19th edition. Mac Graw Hill;1299-1304.

Ruskin JD, Laney TJ, Wendt SV, Markin RS. Treatment of mammalian bite wounds of the maxillofacial region. J Oral Maxillofac Surg. 1993;51:174-6.

Guy RJ, Zook EG. Successful treatment of acute head and neck dog bite wounds without antibiotics. Ann Plast Surg. 1986;17:45-8.

Chavan S, Pawar V, Jain SKT, Bansod S, Sonvani M, Babu MS. A case study of delayed primary suturing in facial injuries following animal bites. British J Med Med Res. 2016;12(11):1-8.

Lackmann GM, Draff W, Isselstein G, Tollner U. Surgical treatment of facial dog bite injuries in children. J Cranio-Maxillo Fac Surg. 1992;20:81-6

M Javaid, L Feldberg, M Gipson. Primary repair of dog bites to the face: 40 cases. J R Soc Med. 1998;91:414-6.

Rui-feng C, Li-song H, Ji-bo Z, Li-qiu W. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: A prospective randomized trial study. BMC Emerg Med. 2013;13(1):2.

Abrahamian FM, Goldstein EJ. Microbiology of Animal Bite Wound Infections. Clin Microbiol Rev. 2011;24(2):231-46.

Galloway RE. Mammalian bites. J Emerg Med. 1988;6(4):325-31.

Maimaris C, Quinton D N. Dog-bite lacerations: A controlled trial of primary wound closure. Arch Emerg Med. 1988;5(3):156-61.

Jain RK, Prakash G, Midya M, Sharma P. Diverse spectrum of facial dog bite presentation and their management. Int Surg J. 2018;5(9):3017-22.

Rui-feng C, Li-qiu W, Lizuo H, Hongbo C. Debridement of dog bite wounds. China Journal of Emergency Resuscitation and Disaster Medicine. 2010;1:23-4.

Rui-feng C, Li-qiu W, Li-song H, Xue-fei W. Distribution and characteristics of infection in dog bite wounds. China J Emerg Resuscitation Disaster Med. 2011;1:21-3.

Rui-feng C, Li-qiu W. The effect analysis of debridement and immunifaction after rabid dog bite. Guide of China Medicine. 2012;5:401-2.

van As AB, Dwyer JP, Naidoo S. Dog bites to the head, neck and face in children. Southern African J Epidemiol Infec. 2010;25(1):36-8.






Original Research Articles