Friday, September 9, 2016

Medical Professional Experts on Treating Victims of Pit Bulls

Surgeons, doctors, and medical professionals expert in treating victims of pit bull attacks.

MICHAEL GOLINKO, University of Arkansas for Medical Sciences, Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution, 2016
Our data confirm what detractors of the breed and child advocates suggest—that, with rare exceptions, children and pit bulls do not mix well. Of the 8 studies listed in Table 5, 6 report pit bulls as the most prevalent breed, and in many cases, they inflicted the most severe injuries.17 A large study at Children’s Hospital of Pennsylvania showed that over a 12-year period, 25% of injuries were caused by a pit bull, and two-thirds of those required an operation.33 Our data were consistent with others, in that an operative intervention was more than 3 times as likely to be associated with a pit bull injury than with any other breed. Half of the operations performed on children in this study as well as the only mortality resulted from a pit bull injury. Our data revealed that pit bull breeds were more than 2.5 times as likely as other breeds to bite in multiple anatomical locations. Although other breeds may bite with the same or higher frequency, the injury that a pit bull inflicts per bite is often more severe.  Consistent with these findings is that of Bini et al,17
http://bit.ly/2byrRC4


DR. BENJAMIN VAN RAALTE, MD, plastic Surgeon, Davenport, IA
"It wasn't until the pit bulls (became popular) that I started seeing the really vicious attacks," the Bettendorf plastic surgeon said Monday. "The worst pit bull mauling I ever saw was an incident in which a dog bit off the entire cheek of a 5-year-old boy."
Of the severe bites he has treated, Van Raalte estimates, more than half have been the result of a pit bull attack. The high number of serious injuries, along with the appalling and increasingly popular "sport" of dog fighting have convinced him the time has come for an all-out ban on pit bull breeding.
"I'm just saying it's time to stop breeding them," he said. "Yes, there are lots of lovable pit bulls. I'm not advocating putting down pit bulls.
"They're primarily bred for fighting. In 2016, we need to say we're done breeding pit bulls. It's primary purpose is to be a weapon. It's doing what it's supposed to do."
http://bit.ly/1TtJ7c5

WILLIAM VINYARD, MD, FACS, Palm Beach, FL
Fact...As a plastic surgeon who has repaired numerous children attacked by dogs, over 90% were by pittbulls.  Every plastic surgeon that I know has the same experience.  This doesn't mean they are horrible animals.  It just means they are less predictable and more dangerous for children.  There is absolutely no denying this fact.

SETH BARUFFI, MD,  South Jersey Healthcare - As an ER doc who doesn't predict what dogs would *never* bite, and, instead, just treats who walks in the door, I can say that pit bulls account for the overwhelming majority of serious bites.  Little happy dogs probably bite more often, but they are minor and require little to no treatment (most probably just stay home).  What pit bulls can do is awful.  The argument of nature vs. nurture is a fun academic discussion, but it is zero help to the little girl with a disfigured face or the parents of a dead kid.  There is no reason to own an animal that can kill you if you are not the dog whisperer.  There is not (sic) reason to own an animal that can kill you at all.  The ban is a wonderful idea.  It hurts no one and it saves kids lives.

DAVID A. BILLMIRE, MD, professor and director of the Division of Craniofacial and Pediatric Plastic Surgery at Cincinnati Children's Hospital Medical Center
"As one who, for the last 30 years, has been on the receiving end of the dog-bite injuries that pass through the Children's Hospital Emergency Room, as well as on the staff at the Shriners Hospitals for Children where we see the late effects of these injuries from across the nation, I can categorically tell you that the problems associated with dog bites are indeed breed-specific."
"Starting about 25 years ago, my colleagues and I started to see disturbingly different types of injuries. Instead of a warning bite, we saw wounds where the flesh was torn from the victim. There were multiple bite wounds covering many different anatomical sites. The attacks were generally unprovoked, persistent and often involved more than one dog. In every instance the dog involved was a pit bull or a pit bull mix."
"...[H]ow many mauled children do we have to see before we realize the folly of allowing these dogs to exist?"
"There are plenty of breeds available that peacefully coexist with human society. There is no need for pit bulls."
http://cin.ci/1mxLgjf

EUGENE F. REILLY, MD, Traumatology, Surgical Critical Care and Emergency Surgery Reading Hospital and Medical Center
"As a trauma surgeon, I can attest to the fact that a large majority of the dog attack victims I see are caused by pit bulls.  This is at least partly because they create a lot more damage than a typical dog attack.  Between the disproportionate number of attacks and the disproportionate severity of the injuries, I'd say the "prejudice" is well-founded.
While most pit bulls may be delightful, the above facts don't change.  The lady who's face was eaten by her chimpanzee might also have argued that chimps in loving homes are generally loving animals - except that once in a while they eat your face.  Once in a while a pit bull attacks - and when it does, the damage it inflicts is considerable." 
http://huff.to/1jJu22t  (find in comments section)

MARK WULKAN, MD, Surgeon at Children's Healthcare of Atlanta
"There is a difference with the pit bulls. In the last two years we've seen 56 dog injuries that were so severe the patient had to be admitted to the hospital so this doesn't count just a little bite and then goes to the emergency room. Of those 56, 21 were pit bulls. And then when we look at our data even further, of the kids that were most severely injured, those that were in the hospital for more than 8 days or had life threatening injuries, 100% of those were pit bulls."
Pit bulls and Rottweilers that attacked children often belonged to the family or the neighbors, a pediatric surgeon in Atlanta said.
"People get this false sense of security" because they know the dog and think it won't hurt anyone.
http://bit.ly/16YubhR
http://bit.ly/1oB4pcX

STEPHEN COHN, MD, Professor Of Surgery At The University Of Texas Health Science Center
“I think this is a public health hazard, this particular dog. We just have to have them contained in a way that protects the general public. I don't want to see another kid come in dead.”
http://bit.ly/GO6ufP

JOHN BINI, MD, Chief Of Surgery At Wilford Hall Medical Center
“There are going to be outspoken opponents of breed legislation, who say: ‘My pit bulls lie with my baby and play with my rabbit.' And that's fine. I just think we're seeing something here, and I think it does warrant a discussion as to whether this is a risk that a community wants to take.”
http://bit.ly/GO6ufP

MORTALITY, MAULING, AND MAIMING BY VICIOUS DOGS, April 2011 Annals of Surgery
“Fortunately, fatal dog attacks are rare, but there seems to be a distinct relationship between the severity and lethality of an attack and the breed responsible,” they wrote in an article published in the April issue of the medical journal Annals of Surgery. “These breeds should be regulated in the same way in which other dangerous species, such as leopards, are regulated.”
http://bit.ly/GO6ufP

DAVID E. BLOCKER, BS, MD, Dog Bite Rates and Biting Dog Breeds in Texas, 1995-1997
Bite Rates by Breed page 23
One out of every 40 Pit Bulls (2.5%) and about one out of 75 Chow Chows (1.4%) generated a reported human bite each year (Table 29; Figure 7). One out of 100 Rottweilers (1%) caused a reported bite, and less than one out of 250 German Shepherds (0.37%) bit a human each year, not statistically different from the average for all dogs combined (0.53%). Huskies, Dobermans, and Australian Shepherds had bite rates slightly lower than German Shepherds but higher than Labrador Retrievers. Less than one in every 500 Labrador retrievers (0.15%) was associated with a reported bite each year. All other breeds examined individually, including Poodles, Cocker Spaniels, and Dachshunds, had bite rates lower than Labrador Retrievers.

Odds ratios for each of the five most commonly biting dog breeds versus all others presented similar findings (Table 30). The odds of a Pit Bull in Bexar County causing a bite were 5 times greater than the odds for all other breeds combined, at 4.9 to 1. Chow Chows and Rottweilers also had odds ratios significantly greater than the average, at 2.9 to 1 and 1.8 to 1, respectively. The odds ratios for German Shepherds and Labrador Retrievers were significantly lower than the average, at 0.67 to 1 and 0.26 to 1.
http://1.usa.gov/1brVTBc

PETER ANTEVY, Pediatric E.R. Physician, Joe Dimaggio Children's Hospital
Dr Antvey sees at least five dog-bite victims a month in his emergency room. Unfortunately, he said, "the biggest offender is the pit bull."
http://bit.ly/KH1gim

MELISSA ARCA, MD
The reality is that any dog can bite, and statistically speaking, a child is most likely to be bitten by the family dog or a dog that they know. When you're talking about bite severity resulting in life-threatening and even fatal injuries, pit bulls and Rottweilers are the main culprits
Experience absolutely colors our perception, and in this case I can't help but be affected by what I've seen. I will never forget a young child I treated in the ER during my pediatric residency. She suffered severe facial lacerations and tears to her face after a pit bull attack in her local park.
http://bit.ly/KH1gim

BB HORSWELL,  CJ CHAHINE, oral surgeons, authors of "Dog bites of the face, head and neck in children"
Dog bites of the facial region are increasing in children according to the Center for Disease Control. To evaluate the epidemiology of such injuries in our medical provider region, we undertook a retrospective review of those children treated for facial, head and neck dog bite wounds at a level 1 trauma center. Most dog bites occurred in or near the home by an animal known to the child/family. Most injuries were soft tissue related, however more severe bites and injuries were observed in attacks from the pit-bull and Rottweiler breeds. Younger (under five years) children sustained more of the injuries requiring medical treatment. Injury Severity Scales were determined as well as victim and payer mix demographics, type and characteristics of injury, and complications from the attack.
http://1.usa.gov/1fxVan5

DR. RICHARD SATTIN, Chief Of Unintentional-Injuries Section Of The Centers Of Disease Control
We're trying to focus public attention on this greatly underestimated public hazard.
In 1979, pit bulls accounted for 20 percent of fatal attacks by dogs. That figure had risen to 62 percent by 1988.
Nobody knows the dog population of the United States or the exact breakdown by breed. We do not believe that pit bulls represent anywhere near 42% percent of dogs in the United States. Therefore, we believe that the pit bull excess in deaths is real and growing.
http://bit.ly/17H4c87

ROBERT D. NEWMAN, M.D.
As a pediatrician I was disturbed to read Vicki Hearne's assertion that there are no bad breeds, just bad dogs (Op-Ed, April 15). There is ample evidence to suggest that certain breeds of dogs are more dangerous to children than others.
From 1979 to 1994, there were 177 known dog-bite-related fatalities in the United States. Of these fatalities, 66 percent were caused by five breeds: pit bull, Rottweiler, shepherd, husky and malamute. If you include crosses among these five breeds, that number rises to 82 percent. Other breeds, like Labrador retrievers and golden retrievers were not implicated in a single fatality during this same period.
I laud the American Kennel Club's attempt to include information about dog breeds considered ''not good with children'' in the coming edition of ''The Complete Dog Book,'' and lament the fact that the book is being recalled at the request of some breeders.
Seattle, April 16, 1998
http://nyti.ms/18iLiJk

Dr. EDGAR JOGANIK (after trying to reattach scalp and ear to a pit bull victim)
Pit bull attacks are typically the most severe, and in about one-third of all attacks, the animals are family pets or belong to close friends.
That should be the message, that these dogs should not be around children, adults are just as likely to be victims.
Everyone should be extremely cautious.
http://bit.ly/16KJTLe

DR. MICHAEL FEALY
When a Pit Bull is involved the bites are worse. When they bite, they bite and lock and they don't let go... they bite lock and they rip and they don't let go.
http://bit.ly/1iOGMu7

DR. CHRISTOPHER DEMAS
Bites from pit bulls inflict much more damage, multiple deep bites and ripping of flesh and are unlike any other domestic animal I've encountered. Their bites are devastating - close to what a wildcat or shark would do.
http://bit.ly/1cq68am

DR. AMY WANDEL, plastic surgeon
I see just as many dog bites from dogs that are not pit bulls as bites from pit bulls. The big difference is pit bulls are known to grab onto something and keep holding so their damage they create is worse than other breeds.
http://on.news10.net/wjjZ0A

ANDREW FENTON, M.D.
As a practicing emergency physician, I have witnessed countless dog bites. Invariably, the most vicious and brutal attacks I have seen have been from the pit bull breed. Many of the victims have been children. In a recent study from the Children's Hospital of Philadelphia, pit bull attacks accounted for more ER visits than all other breeds combined.

In young children, the most common part of the body injured was the face. Numerous studies have proven that the number-one cause of dog bite fatalities is the pit bull breed. I am certain that many attacks are due to owner negligence, but the fact remains that many were unpredictable and were perpetrated by formerly "loving and loyal" pets.

Dr. Chagnon has every right to leave our town as she claims she will if pit bulls are banned, just like every one of her patients has the right not to attend her clinic where she brings her pit bulls. I applaud Mayor Pro Tem Joanne Sanders for bringing this issue to the forefront. In the interest of public safety, I recommend we enforce a spay/neuter requirement on pit bulls while reviewing and revamping all of our policies relating to animal bites.

DR. PATRICK BYRNE, Johns Hopkins Hospital
I can't think of a single injury of this nature that was incurred by any other species other than a pit bull or a rottweiler.
http://bit.ly/1aFuieL

JUGPAL S. ARNEJA, MD, FRCSC, KARA PAPPAS, B.S., WILLIAM HUETTNER, M.D., ARLENE A. ROZZELLE, M.D., GURBALBIR SINGH, M.D., FRCSC
A ten-year, two-institution review of pediatric dog attacks: Advocating for a nationwide prohibition of dangerous dogs
PURPOSE:
Affectionately referred to as ‘man’s best friend’, dog attacks in the pediatric population often test this analogy. Pediatric dog attacks are a significant public health issue that negatively affects the psychological well-being of a child. We performed analysis of our cumulative two-institution pediatric dog attack data, present representative cases and offer evidence to support a nationwide prohibition of dangerous dogs.
METHODS:
A retrospective review was performed at two urban Children’s hospitals from 1996-2005 of all dog attacks presenting to the plastic surgery service. Charts were reviewed with analysis of patient demographics, injury site, operative intervention, and dog-specific data.
RESULTS:
109 patients were included for review, with 83% of attacks occurring in the facial region. Mean age was 3.9 years (range 2-18 years). 67% of attacks involved multiple anatomic sites, 95% required surgical intervention with 30% requiring a skin graft or flap reconstruction. 88% of dogs were known to the victim, 46% of attacks were provoked, 73% of dogs were euthanized and 57% of dogs were deemed to be of a dangerous breed (Pit Bill or Rottweiler). Mean hospital duration was 4.7 days and 27% required additional reconstructive plastic surgery. Figures below illustrate a representative case of a 4-year old female attacked by her aunt's dog, resulting in a complete nasal amputation, preoperatively (upper), at time of forehead flap reconstruction (middle), and five years post-operatively (lower), with an acceptable functional and aesthetic reconstruction.
CONCLUSION:
Dog attacks in the pediatric population produce significant costs including physical morbidity, psychological disability, and financial strains. A majority of attacks were by a known dog, in the facial region, by dogs which we define as of a dangerous breed. Much of the injury patterns are unique to children and these injuries and associated costs can be significantly diminished, as the problem is often preventable. Our cases present the ‘tip of the iceberg’ as our cases only represented consultations directed to Plastic Surgery. The Province of Ontario, Canada has banned Pit Bulls since 2004, as have several American cities. We describe the scope of the problem, preventative guidelines, and outline why organizational advocacy in plastic surgery should be directed towards a national prohibition of dangerous dogs.
http://bit.ly/GQciW7

M. A. DEWAN, EDWARD J. WLADIS, Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, NY
Periorbital trauma from pit bull terrier attacks.
PURPOSE
To report the nature of periorbital trauma after pit bull attacks. While these attacks have been well-characterized in the popular media, no case series has documented the ophthalmic manifestations of this trauma.
METHODS
We retrospectively reviewed all cases of pit bull terrier attacks that presented to the oculoplastic and orbital surgery service at Albany Medical Center between 2008 and 2011. The age, gender, extent of the injuries, care provided, follow up interval, and complication rate were evaluated for each patient.
RESULTS
Seven patients were identified, with a mean age of 17.2 years. Six of the seven patients were in the pediatric age group. All patients suffered eyelid lacerations, and only one patient had additional injuries. Four patients (57.2%) suffered a canalicular laceration. Despite the lack of post-operative oral antibiotic use, no patient developed a wound infection.
CONCLUSIONS
In the ophthalmic setting, pit bull terrier attacks most frequently involve children and result in eyelid lacerations. Canalicular injuries are common after these attacks.
http://bit.ly/1hUA6E2

Adapted with thanks from Craven Desires and The Truth About Pit Bulls