頭頚部よく創例

Abstract

Impalement injury is a penetrating and contusive wound with two distinct characteristics; stab and blunt trauma. We encountered a 52-year-old male with impalement injury by two iron rods through the chest to the neck, pharynx, paranasal sinus, orbita, and forehead. As the stakes damaged the bilateral optic nerve, he had lost vision at the initial visit. Computed tomographic examination of the head, neck, and chest was performed to evaluate the organs and degree of injury. Although the iron stakes caused artifacts on computed tomographic testing, the examination was still beneficial to detection the penetrating route and the degree of injury to various organs. Sufficient exposure of rods without causing additional vascular injury, repair of injured organs, exhaustive debridement and drainage were carried out. Fortunately, we could save the patient's life. The following therapeutic strategy for impalement injury was used: 1) injured organs, especially large vessels, should be assessed before surgical treatment; 2) impaled objects should be extricated after protection of large vessels; and 3) thorough debridement, wound drainage, and administration of tetanus toxoid and antibiotics are nessesary.