Dogbites and Reconstruction
Dog Bit Me!
Dear Dr. Bermant,
I got bit by a dog about 10 days ago and was in plastic surgery for
2 hours.(with over 100 stitches in my chin and mouth) I have been
spending a lot of time at your website and can not tell you how informative
it has been. The surgeon that "put my face back together"
did an increadible job; and I thought that this would "be a good
thing", however you say in Scar Correction "chances
for improvement are less if the wound was closed with skill and there
are no complications" (such as infection...and there was none)
Now I am a little confused....was this a misprint? Can you explain?
Would really appreciate it since I know I have at least another year's
worth of cosmetic surgery to look foward to.
Thank You,
Dr. Bermant Responds:
Thank you for your comments. I prefer to try and minimize the scar with the first surgery and try to prevent the need for revision surgery. Having the first repair done with more skill means that there may be less margin for improvement with a second surgery. This refers to some of the scars I have seen that were repaired by nonplastic surgeons not using some of the techniques we may have used at the first repair. Such a deformity may benefit from one of our many scar revision procedures. You may be lucky and not need further surgery, be patient and see how your scar evolves. Follow your surgeon's advice for scar care.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
My Puppy
Dear Dr. Bermant,
All my life I've wanted a dog, and now that my parents finally gave
in, I want to make sure that i'm doing everything right. My dog is
3/4 pit bull and 1/4 black lab. She has large paws and most likely
will be about or over 50 pounds. She's only 12 weeks old now, and
I want to make sure I'm not overlooking any possible warning signs
of a possible future accident. Unlike most other puppies that indiscriminantly
bite and chew everything, she seems to have more of an strikt pattern.
She is the smartest puppy I've ever seen. On the first walk i gave
her, she imidiatly knew which house was ours on the block after being
with us for only a day. I've only had her for 2 weeks, and before
then she lived in a kennel almost completly neglected all day. When
I walk my neighbor's dog, (a huge Akita Pit bull mix) she attacks
her. My friend said that I need to have her around bigger dogs more
often so that she gets beaten up and learns her place. She gets jaw
lock often and I'm afraid to have
her around small children such as my little sister who doesn't know
when enough playing is enough. She's very protective. She won't let
strangers in the house. Do you have any suggestions? Any advice would
help. I don't want to have to get rid of her. In two years I'll be
going away to college and at least the possibility of family members
getting injured would no longer be a problem becase i'm bringing her
with me.Thank you for all your help. I don't have an email address
yet, but you can write back to me if possible at ...
thank you again!
Sincerely,
~V
Dr. Bermant Responds:
A dog can be a wonderful companion, protector and family member. It also can cause massive destruction. An inadvertent tooth getting snagged on a child's cheek can leave a terrible scar. An understandable snip telling the invader to leave me and my bone alone can cause more damage. Grabbing on angrily with the jaws can cause great destruction. Nothing in life is safe. It is impossible to advise anyone about keeping or getting rid of an individual pet. Young children do not pick up a dog's body language that an adult should understand (not all adults look for the communication, comprehend it, or want to listen). In my mind there is no room for a nasty pet around children, the mixture is a formula for disaster. A loving pet is less risk, but the risk still is there. Not all injuries are intentional.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Police Dogs in the Statistics
I've have been told on several occasions that the reason that German Shepards are so prevalent in the statistics of "biters" is that the statistics include all occasions in which police-trained Shepards have been ordered by their police handlers to "bite" i.e. do that for which they are trained and employed by the police in the course of law enforcement activity. I own a very passive Yellow Lab but encounter Shepards all the time and they seem no more inclined to bite nor any more aggressive than any other breed. I was wondering if you have any comment on this.
Dr. Bermant Responds:
You will have to ask the people who conduct the studies this question. I have certainly seen my share of German Sheppard dog bite injuries but I do not keep my own statistics. The nature of a dog can depend greatly on how it is trained and raised but I doubt I will ever see an attack miniature poodle used on police canine patrol. And yes, any breed can be brought up to be a nasty dog.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
'Ultrasound' Dog Repeller
Hi Dr Bermant,
I'm looking for a device which I've heard about that emits a sound at a frequency which dogs can hear and which is used to repel them. They're unavailable where I live (in Ireland) and I've been told that I need to get them in USA. Do you have any idea where I can get such a device by mail order ? I have to travel by bicycle on a route which, unfortunately, has recently acquired a viscious greyhound which roams free and has attacked me twice already - so any information you may have would be greatly appreciated.
Thanks and Regards,
K
Dr. Bermant Responds:
sorry no idea
DOG BITE
HOW ELL DOES EAR CARTILEGE HEAL? HOW WELL DOES BROKEN SKIN HEAL OVER CARTILEGE?
IF YOU HAVE ANY TIPS ON DOG RETRAINING FOR THE GUILTY PET PLEASE SEND THEM
THANK YOU
Dr. Bermant Responds:
Ear cartilage heals better when covered by living skin. Early closure of an open wound usually does better than leaving it open. Wounds infected or left open may not easily be closed. It is impossible to comment without examining the defect.
You will need to consult someone else about the dog.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog Bites
Your page on dog bites was very good with many helpful suggestions.
However, as a dog trainer, I must take exception to your statement
about unprovoked bites. All dog attacks are provoked--from the dog's
point of view. If we cannot recognize the provocation, the dog still
can.
J
Dr. Bermant Responds:
You are WRONG. Some dogs are not suitable around children. I have treated unprovoked dog attacks. In one the animal broke its restraint went over a fence into another backyard and took the face off of a child minding its own business in a sand box out of view of the other yard. You can try to twist it any way you want, but this dog idea of provocation was the existence of something anywhere. You cannot justify domain nor teasing nor taking food. The statistics are from articles on the subject where many animals creating the bites belonged to drug dealers and other inner city undesirables. Some animals are hunters and killers and do not need any provocation. Some have been trained that way and are a danger when unrestrained. We will let you explain to the mutilated child and their family how they provoked the dog next time.
Michael Bermant, MD
Dog Bites
I am afraid that you misunderstood my point. I also believe
that some dogs are dangerous and cannot be trusted, particularly around
children. Thirteen years ago, I put my obedience dog, a dog I had
spent countless hours training, to sleep. She growled at my infant
son. I gave her three chances, then put her down. I did not wait until
she bit him. Still I believe that she, in her mind, was provoked.
I guess I am splinting hairs here but I maintain that all dog attacks
are provoked--the provocation is frequently unjustified. I also believe
that, by tagging some breeds as inherently dangerous, we are missing
the point. Dogs of any breed can, and do, bite. We have to be alert
to the individual dog that poses a threat. Irresponsible and foolish
owners are the problem!
J
Dr. Bermant Responds:
I am sorry for what you had to do with your dog.
I agree, but some dog breeds have a basic temperament and anatomy that makes the average dog of that breed more dangerous than an average dog of another breed. Which is the more important factor, the underlying nature, or the overlay of owner training, I do not know. I have seen many Pitt Bull and Rotweiler wounds, and none by a St Bernard nor Great Dane. Anatomy and strength of jaw are not the only factor.
Michael Bermant, MD
Dog Bite Scars
Dr Bermant,
I am desperate to find more information about scar revision. I deeply
apologize for the length of the letter, but I was so impressed by
the sincerity of your web site that I felt compelled to ask you for
your help. I realize that you are not in my area, but I was hoping
that you could offer me some advice. Anything you could send to me
would be most appreciated. My daughter was attacked by a dog and has 7 severe puncture mark scars
(some larger - but most about the size of a dime) on her mid to upper
thigh. The area of the bites clearly indicate that she never saw the
neighbors dog coming until he clamped onto her leg. She was steri-stripped
and not stitched, because of infection reasons. It did drain for a
couple of weeks.
My now 10 year old daughter was extremely shy and her self-esteem
has plummeted enormously since the addition of these scars. She is
amazingly beautiful but often calls herself "ugly" and "disgusting."
We are continually working on the emotional issue, but the physical
issue is what has me so confused. The scars are keloid in nature (she has naturally, dark tan color
skin).
I was told by a plastic surgeon in our area that, although the scars would never go away, he could do several dermabrasion treatments which could contour the area for a better appearance. His estimate was 2 to 3 treatments over several years and, taking into account the future estimated cost of treatment, we believed that the $20,000 (all cost for 3 surgeries) was a fair cost estimate. She is due to have a major growth spurt in the next few years and I was told that the scars could widen, lengthen and broaden. They could get worse and not better.
We recently decided to sue the neighbors insurance company for damages.
The insurance company doctor told us that there was really no treatment
available to lessen scars such as these and that "what she has,
she will always have". He saw no point in treating the scars
and his cost estimate for the insurance company was a simple $900.00.
We are asking for the $20,000.00.
I am not asking you for an estimate for scars that you have not seen. I just need as much information as possible because the insurance company will not even settle for the $20,000 it will cost to repair her leg and we will reluctantly be headed for court next month.
On a very personal note: the insurance company found out that my daughter
was adopted by us, just prior to the age of 2 years old. They have
relentlessly dug into her "past" and found allegations that
she MAY have been abused by her biological parents. They plan to use
this information against her in court by stating that she was traumatized
far before the dog bit her! I am stunned by this legal process and
I do not want my daughter (and her 4 biological siblings, also adopted)
to go through this painful humiliation. They are beautiful children
who deserve the right to privacy and have lost that right because
of a dog attack.
Your section on dog attacks was wonderful and my daughter found it
to be helpful to see that these things happen to a lot of other children.
Thank you so much for taking the time to display that information
on your web site, and thank you so much for taking the time to read
such a lengthy E-mail from an obviously distraught mother!
If you could send me any information regarding dog bite scars or scar revision via E-mail or through regular mail, I would be most appreciative.
If you do have ANY information to hard copy me, please E-mail me and I will provide you with my complete mailing address. I would be willing to travel the 600 miles to you if I thought that my daughter would have a better chance to correct her scars!
Again, thank you. Your site is a wonderful service which you have
offered to the public and if there is anyway that I can help you,
please let me know.
D
Dr. Bermant Responds:
Dog bites can be very emotional trauma that can persist in the scars that remain. As surgeons we cannot erase scars, only try to improve them. Without an examination, I am at a disadvantage compared to your other surgeons. Some scars can be improved with various techniques. A scar that heals by secondary intention frequently can be surgically revised. This may improve the dynamic nature and appearance but not erase the scar. Sometimes there is only a contour irregularity. This may be improved with one of several contour improving surgeries such as the dermabrasion.
Scars may be bad looking without being keloid in nature. Keloids tend to extend beyond the margins of the original scar. Keloids are another problem altogether and are not usually treated by dermabrasion. The therapy is designed for the particular scar and may involve many different types of treatments.
I cannot recommend treatment without an evaluation. I cannot comment on the wide range of prices, neither makes sense from your description - but that is not fair to the doctors who have had a chance to examine you.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Facial Dog Bite
Currently I am starting up a business in England, although
my family resides in Virginia Beach .VA.
I am currently pursuing a law suit case with the owners 'home owners'
insurance, and after reading your web page am concerned that the insurance
will not cover "cosmetic work". I just had a conversation
with my attorney today and he advised me to have a plastic surgeon
evaluate my condition and approximate cost of repairs.
Thank you for taking the time to read this, and I look forward to
a response.
Dr. Bermant Responds:
We do reconstruction of dogbite injuries, both acute and late. Prevention is better than reconstruction, that is why I have posted the information on the internet. In addition we provide doctor evaluations for the legal profession. Jane from my office can give you the particulars.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Daughter Attacked by Dog
Dr. Bermant,
My three year old daughter was bit on the face by a neighbors dog back in July. The wounds were terrible. She suffered a number of deep puncture wounds as well as a slash from the canine fang that runs from the corner of her right nostril down her smille line and then forms a "j" along her cheek. It has been five months and it is difficult to see much improvement from the original surgical scars. What are our options if after the next 18 months there is no improvement? Is there any expiremental treatments you are aware of?
Sincerely,
B
Dr. Bermant Responds:
You should consider having an evaluation by a competent board certified plastic surgeon. We see many such patients. There may be many reasonable options for scar modification or improvement well before anyone needs to start with "experimental" methods.
Unfortunately the body heals with scars, it just depends on the nature of the individual scar. Unrealistic expectations result in unhappy patients.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog Bite on Face and Need Help
MY NAME IS S... AND I HAVE 2 DOG BITES ON MY FACE THAT HAPPENED AT AGE 3 AND WERE REVISED AT 16. I WOULD LIKE TO KNOW IF ANYTHING ELSE CAN BE DONE TO REVISE OR IMPROVE MY SCARS AND IF U ARE ABLE TO DO THIS FOR ME. I AM 25 NOW AND AM LOOKING FOR A DOCTOR SPECIALIZING IN FACIAL DOG BITES. YOU SEEM QUALIFIED. PLEASE SEND ME INFO..
WOODSTOCK, GA
Dr. Bermant Responds:
Scars can be an emotional problem Some scars benefit from revision. Scars have both a dynamic and static component. I need to see how the scar is both still and in motion. Without an examination and evaluation, I cannot tell you if I can help you.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog Bite
hello,
My daughter was bite by a dog in august. The dog bite her once in the face. The bite tore her bottom lip into ripping it right below her chin. There was also a tear from the middle of her fore head to behind the ear. The one on her forehead is healing wonderfully!!!!!! The one that ripped her lip into is lumppy and kind of sticks up a little. The question I have is when is a good time for plastic surgery? I mean plastic surgery on the lip. She is going to be 4 in June. I would appreciate any information you could give us.
Thank You,
K..., A Concerned Mother
Dr. Bermant Responds:
The best time for a plastic surgeon is during the first repair in the emergency room if the injury cannot be prevented (see my dog bite brochure). When I do the first repair / reconstruction I try to rebuild the tissue such that a revision is not necessary. When I am involved from the beginning I then can comment when I feel that the injury warranted an earlier revision or second stage. I try to let the scar evolve over the first 4-6 months to see what the injury, my work, and the body's natural healing end up with. In most cases I can push the wound during the first encounter not to need a revision.
In those cases where others have not done such pushing, the revision may be better early. Why wait for something to evolve when basic alignment is off, the edges do not match or other major problems exist? In these cases, I try to wait until the original psychological impact wears off enough to bring the patient back to the operating room. I would have to see the scar / deformity before making such a recommendation. Otherwise waiting for the initial healing is very reasonable - 4-6 months.
Sometimes I can influence the maturation of a scar with suggestions dependent on what an in office consultation and examination would help me decide which to recommend.
Seeing a plastic surgeon early is the best. If one did not do the repair there are other possible benefits. Surgery revision recommendations depend on what is found on examination.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog Bites
Six months ago we bought a 3 year old cocker spaniel. He
is a neutered male and when we got him, we were told that he was very
good with kids. A couple of months after we got him, he nipped my
13 year old son. My husband and I wanted to get rid of the dog, but
both of our kids begged us not to. I called my vet's office and was
told that this can be a problem with cockers. I asked if obedience
school would help and was told that it was possible, but there were
no guarantees. I called the schools they recommended and was told
that, in their opinion, the dog was trainable. I've been to one class
and was putting the training into practice when the dog bit me. Were
we mislead by the school about the possibility of training this dog?
Is it even safe for us to have the dog? I would really appreciate
your opinion. Thank you for taking the time to read this.
A
Dr. Bermant Responds:
My expertise is in the repair and reconstruction of dog bite injuries. In asking my patients about their injuries, any dog (under the right conditions) can bite. Training seems best from a very early age but from what others have told me is possible even in older dogs. Training older dogs will take certainly some time. Some animals have many years of untraining to do. Others are just not right for people and children and are better off for the protection and guarding roles they have taken.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog-Bite Prevention
I have read your web page on dog-bite prevention with interest as I am currently looking at this problem for a UK electricity board whose meter readers are at risk in the course of their normal work. As it will be at least a couple of years before remote reading of meters becomes possible, their Safety Officer is very anxious to know of any measures which could be taken in the meantime to reduce the risk of being bitten. They are trying out a deterrent spray (Bite Back) but find that protective clothing is unpopular, particularly in summer. If you could help me with either of the following queries (or point me in the direction of other experts or publications) I should be most grateful.
1. Is there a known psychological profile or personality trait which differentiates those who are likely to be bitten by dogs from those who are less so?
2. How should meter readers be trained to behave when encountering a dog on its owner's property?
With many thanks,
P (Research Psychologist)
Dr. Bermant Responds:
As a plastic surgeon my expertise in the repair and reconstruction of the dog bite injuries. Over the years I have tried my best to learn how to prevent the anguish and trauma from the more devastating injuries. I searched the literature about dog bites to generate the posted material. There is not really much on the psychological profile of which dogs are more likely to bite nor on the people more likely to be bitten. Remember my patients are usually not the best ones to learn from. They are the ones bitten, not the ones who have avoided injuries. There have been more than a few kennel owners, groomers, and breeders who have explained that they knew they had "done the wrong thing" to get bitten.
Major issues are probably the territory aspects. The meter reader is coming to the territory that the dog is "defending." When vocal and body language indicates, perhaps that house needs to be passed up. That may address the dog behind a fence, but what about the roaming dog? Challenging a dog with sprays and protective clothing may be a problem if depended on too greatly. Emphasizing typical dog behavior around a possessions (food or toy) or puppies may prevent other injuries. There are also body language that may be valuable to teach.
What is outlined in the brochure was designed for the general public. I may be able to generate material for your specific needs if you want a consultant. It can be as background material, brochures, or multimedia - I have delivered in many educational formats. What I am afraid of, is that both the people and the dogs are likely to "not obey the rules." There is just too much variability for such material to be completely reliable.
I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.
Michael Bermant, MD
Dog bites of Lip and Reconstruction Photographs (graphic)
Dog bite Injury Face Repair / Reconstruction Photos (graphic)
Camel Bite Reconstruction
Find books about dog bite prevention from Barnes and Noble
Bite Injuries Reconstructive Surgery bulletin boards, forum, experiences, and chat.
