When I was in ER practice I was often asked about what cases terrified me the most. Most people would imagine things like hit by cars or devastating surgeries or obscure toxicity cases. Those could be scary but my answer was always the same....dog fights. Big dogs attacking little dogs, big dogs attacking big dogs or the worst of them all.....any size dog attacking a cat. Dog bite wounds still scare me more than anything else. And it isn't because of infection or spread of disease or even the obvious things like bleeding or broken bones. It's because these cases often look very simple. From the outside sometimes you may only see a few small, harmless-looking, wounds to the skin. It's what is happening below the surface that frightens me.
When I was teaching the interns at the ER hospital I always told them to expect the worst when it came to bite wounds. "It's the tip of the iceberg" we would say. That little skin wound is hiding a world of disaster below the surface. The cases that presented with huge open wounds were honestly the easy ones...often the owners could see the damage that was done. It was even better if there was a broken bone because that is easy to understand. But trying to explain to an owner that their dog or cat that appears fine and just has a few small wounds to its neck or abdomen could be in life-threatening danger is tough.
Humans produce about 150 pounds of pressure when we bite down on something - compare that to the average dog who ranges between 235 pounds of pressure (American Pit Bull) and over 300 (Rottweiler). Take that force and add in the length, usually around 2 inches in a large breed dog, of the average canine tooth (the long pointy one that usually does the biting) and you can see the damage that can be inflicted.
When we are examining the skin surface we are merely looking at the entrance wound - we don't know what has happened to the underlying muscle, fat or worse. Wounds present over the chest or abdomen can easily have traveled into the body damaging vital organs or lacerating important blood vessels. I encountered this several times in ER practice after taking a patient to surgery to determine any internal injuries - it still amazes me that a dog can look fairly stable on the surface and have catastrophic injuries internally. I have seen intestines ripped apart by dog bite wounds and the only thing noted on external exam were 2 small puncture wounds over the abdomen. I once saw a pancreas torn in half - again the external wounds were pretty minimal. This is a perfect example where looks can be deceiving.
Our job as doctors in these cases is to try to uncover as much damage as we can - often this can be difficult especially if owners do not feel that their pets are in trouble or are seriously injured. A dog I recently saw came in for several dog wounds that occurred the day before. On initial exam the wounds were numerous and infected but it wasn't until we anesthetized the patient the next day to explore those wounds that everyone could see the extent of the damage present. If we had not opened the wounds up and removed all the dead and infected muscle and tissue we could have set this dog up for disaster.
So when good dogs turn bad or simple playdates turn ugly and Fluffy ends up with some bite wounds, please take the time to have your veterinarian take a look. They may be very minimal wounds but if we can't tell from the surface, how can you?
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