Animal bite repair at UMMC can call for special care, reconstructive surgery
Media Contact: Ruth Cummins at 601-984-1104 or firstname.lastname@example.org.JACKSON, Miss.
– Dr. Ricky Clay will never forget the day when his neighbor’s German shepherd rushed at him, teeth bared, and zeroed in on his face.
“One of my most vivid memories is his mouth, wide open,” said Clay, professor of plastic surgery at the University of Mississippi Medical Center. “It was a trained attack dog.”
But at age 4, Clay didn’t know that. He’d noticed the dog’s tangled chain was keeping him from his water bowl. Clay brought the bowl to the dog, “and I decided to pet him,” the doctor remembered.
Today, Clay specializes in reconstructive surgery, helping patients who suffered animal bites much more complicated and potentially disfiguring than the puncture wounds he sustained. “I mostly just got a tetanus shot,” he said of his bites, which left no long-lasting scars. “That was before there was a lot of plastic surgery for that.”
News that a child or adult has been bitten or mauled by an animal – in Mississippi, often a pit bull attack – usually focuses on what happens before a victim reaches a hospital. The aftermath, however, can be months, even years, of care and reconstructive surgery.
And, as recent experience has borne out, more bites tend to occur during the summer when kids are out of school and families are outdoors, Clay and other physicians say.
“I’ve seen arms chewed to the bone, and tips of noses bitten off by horses and even humans,” Clay said. “There is no typical bite. So many bites now are from dogs trained to be cruel. They bite and chew and break, but most protection dogs grab and hold on.”
And, he’s seen some unlikely scenarios. “One of the worst bites I’ve ever treated was a bite from a toy French poodle. His owner picked him up and held him close to her face to kiss him. He bit off her top lip,” Clay said.
At UMMC, bite victims are first seen by physicians in the Emergency Department who perform the primary repair and closure of wounds, Clay said. “We see them secondarily and manage their care from there.”
“We want to know the mechanics of the injury – the type of animal, and the extent to which the altercation occurred,” said Dr. Alan Jones, professor and chair in the Department of Emergency Medicine. “If we can’t locate the animal, we have to consider whether to administer the rabies vaccine.”
Bites severe enough to require stitches warrant immediate medical attention. “Oftentimes, it’s a higher risk to close a wound caused by punctures than to leave it open. Bacteria from the mouth can be introduced into deeper tissues, and you’d be closing an avenue and allowing an infection to take hold,” Jones said.
“Of the components of the injury that are repairable, what’s the extent of the underlying tissue injury?” Jones said. “Sometimes, that’s substantially worse that what’s on the surface. It can be the crush, rather than the sharpness, of the bite.”
Animal-bite patients and their families frequently are traumatized when they arrive for treatment. UMMC’s chaplain staff is waiting to hold hands, listen, and give spiritual care.
“I work in tandem with the social worker in the ED to make a human chain of information. The families need to feel like they’re part of what’s going on at a time when they’re in trauma,” said hospital chaplain Doris Whitaker. “We enter into that uncomfortable space where they are. Sometimes, just being there is enough.”
Clay and UMMC’s team of plastic surgeons have successfully navigated some worst-case scenarios: Noses so mangled that the patient has trouble breathing. Eyes so damaged that the victim has lost sight, or is in danger of losing it.
Dr. Kyle Lewis, assistant professor of oculoplastic surgery in the Department of Ophthalmology, annually performs about six to 10 repairs of lacerated eyelids and tear ducts. “When a dog bites the face, where its upper teeth usually go is right beneath your eye,” Lewis said. “A lot of times, the tooth will go behind the eyelid, and the weakest part is in the corner, where the tear duct is.”
Although it’s routine to perform such surgery within 48 hours of the injury, infections and the need to develop mature scar tissue can delay the process, Lewis said. It’s more uncommon for people to suffer bites to their actual eye, which can result in loss of sight or the eye itself, he said.
Like Clay, Lewis strives to restore both function and appearance for patients, many of them children, through his specialization.
“My number one goal is to restore their function. My secondary goal is to improve what they look like,” Clay said. “I told the parents of one of my patients that my goal is to give her the best high school graduation picture I can give her.”
Before Clay begins the reconstructive surgery process, “the first thing you look for is a stable closed wound, so that the person can continue healing while you work on that one place,” Clay said.
If a child is in the middle of a growth spurt or about to begin one, he waits.
“You step back, and you look at the bony structure of their face. If it has to be rebuilt, where can you get the tissue? Where can you get the bone? It’s very hard to get enough of this from a very young child, so you may have to wait to do their surgery.
“You look at the scars that form. Do you have to remove them? Do you smooth them with a laser? If you remove a scar surgically, then you can at least control its lines. We sometimes take straight scars and make them jagged to better hide them.”
In his two-plus years at UMMC and in his practice before that, Clay said, “I’ve treated in the hundreds of bites. There’s only a handful that stick in your mind.”
One is a little girl chewed by a pit bull. “The dog buried her in the mud, and the police found her because her hand was sticking out of the mud. She lived,” Clay remembered. “We worked on her for about seven hours.”
He gives hope and understanding not just to victims, but to their families.
“I’m here to help, and I will work with them as long as I can to make it the best that I can,” Clay said. “It’s gratifying when they come back to you, and it’s the first time that you see them smile.”