Severe Craniofacial Scalping Secondary to a Dog Attack:

A Case Report

Abstract

Dog bites remain an important public health issue worldwide, particularly when they involve the craniofacial region, where soft-tissue vulnerability and aesthetic–functional relevance significantly increase morbidity. High-energy attacks, especially those caused by powerful breeds such as pit bulls, are associated with extensive avulsion injuries, complex lacerations, and potential exposure of deeper structures, often requiring multidisciplinary emergency management. We report the case of a 52-year-old woman who was attacked by two pit bull dogs belonging to her household, resulting in a large scalp avulsion involving the right parietal region, frontal soft-tissue loss, multiple nasal lacerations, and exposed calvarium. Upon admission, the patient was hemodynamically stable but complained of severe pain at the bite sites and intense frontoparietal headache. Her vital signs reflected an adrenergic response to trauma. Intravenous analgesia with dipyrone, tramadol, and ketoprofen was administered, followed by copious irrigation of all wounds using normal saline, chlorhexidine for cutaneous borders, and an aqueous antiseptic solution for the periocular area, in accordance with recommended decontamination protocols aimed at reducing polymicrobial infection risk. Given the severity of the injuries and potential exposure to the rabies virus, complete post-exposure prophylaxis was initiated immediately, including administration of human rabies immunoglobulin and vaccination according to international guidelines. The patient was transported to the operating room, where the procedure was performed under general anesthesia due to the extent of the injuries and the need for extensive manipulation. Meticulous debridement of devitalized tissue was followed by tension-free approximation of viable wound edges to reduce calvarial exposure and prepare the recipient bed for future staged reconstruction. Broad-spectrum intravenous antibiotic therapy with clindamycin and gentamicin was initiated to cover aerobic and anaerobic organisms commonly isolated in dog-bite wounds. The patient remained hospitalized for five days, during which she received daily wound care, analgesia, and close clinical monitoring. She progressed without signs of cellulitis or systemic infection, demonstrating favorable early healing. This case underscores the potential severity of craniofacial dog-bite injuries and highlights the necessity of rapid, evidence-based, multidisciplinary intervention to minimize complications and optimize reconstructive outcomes.