In my reconstructive plastic surgery practice, I favor the immediate closure of dog bites to the face.
This requires extensive cleaning of the wounds but with good numbing in the emergency room I find it this is a step that can be undertaken to decontaminate the wound enough for immediate closure.
The key first step is to numb up the wound completely. I favor a nerve blocks when appropriate. I also favor diffuse local infiltration of the wound, including the Deep surfaces of the wound.
After that probing while irrigating if the wound is big enough I probe with my finger. If it is a small wound I probe with hemostats I spread the skin open I gently scrape the wound all while diffusing copious amounts of normal saline.
Adequate debridement of devitalized tissue is also important.
this results in a clean wound that can be closed with close follow-up. I also favor post-operative antibiotics for dog bites Augmentin being the medication of choice in non pcn allergic people.
Example below is a patient who lost soft tissue due to dog bite. She was the reconstructed with a local tissue flap immediately on presentation to the emergency room.