Soft Tissue Lacerations Research Articles

Incidence and Severity of Maxillofacial Injuries During the Second Lebanon War Among Israeli Soldiers and Civilians

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

Einsatzmöglichkeiten kleiner Fixateure

In addition to the well known techniques of internal fixation, the use of a small and/or minifixator in fracture stabilisation of the hand has gained in popularity among hand surgeons. The advantage of this technique is the possibility for a closed reduction resulting in a minimally invasive operative technique. The minifixator is the first choice of treatment in open or infected cases of fractures and also in cases with complicated soft tissue lacerations. The technical features of the fixator must take into account the dimension of the hand skeleton. A knowledge of the basics of fixator use for fracture treatment must be accompanied by a detailed knowledge about anatomic and functional hand physiology. With an adequate apparatus in most of the cases, a joint-bridging application of the fixator can be avoided. A consequent postoperative physiotherapy should start early to reduce a risk of stiffness. A disadvantage is the necessity for regular pin care. However, with adequate experience it can be reduced to a minimum. The fixator is a very useful apparatus for temporary stabilisation and also as a standard surgical fracture treatment procedure.

Bone harvesting at the anterior iliac crest using piezoosteotomy versus conventional open harvesting: a pilot study

The objective of this study was to evaluate piezoosteotomy for bone harvesting at the iliac crest in a pilot collective. Thirteen patients underwent anterior iliac crest bone graft harvesting using piezoosteotomy. These patients were compared to an age- and sex-matched retrospective cohort of 13 patients who underwent bone graft harvesting at the anterior iliac crest using conventional chisels and saws in an otherwise identical protocol. Harvested bone volumes and operation times were comparable; hospitalization time was briefer and pain levels at the first 2 postoperative days less in the piezoosteotomy group; pain medication requirement was comparable. Spearman's-rho correlation showed a strong tie between pain medication requirement and harvested bone volume in the piezoosteotomy group and between harvested bone volume and operation time in the conventional surgery collective. The correlation between required pain medication and harvested bone volume together with lower pain levels in the piezoosteotomy group indicate pain more exclusively related to local osseous damage than to correlated soft tissue lacerations. Conventional technique shows a correlation between operation time and harvested bone volume indicating a more time-effective procedure, although total operation time was comparable. Piezoosteotomy appears to have potential use in iliac crest bone harvesting.

Healing pattern of experimental soft tissue lacerations after application of novel topical anesthetic agents – an experimental study in rabbits

Topical anesthetics based on a combination of 2.5% lidocaine and 2.5% prilocaine are efficient in eliminating pain from needle stick when placed on skin and oral mucosa. This suggests their application in soft tissue lacerations before suturing to enable pain-free exploration and suturing of traumatic lacerations without prior injection needle stick. The aim of the present study was to study the healing of experimental oral lacerations after topical anesthetic substances were placed in the lacerations. Thirty-six standardized incisions were made bilaterally in the lower and the upper labial mucosa of nine white New Zealand rabbits. All wounds were intentionally contaminated with saliva to simulate laceration wounds in trauma situation. EMLA cream and Oraqix thermosetting gel were applied into 30 lacerations and six lacerations were left untreated as control. In some lacerations the topical anesthetic agent was left in the wound, while in others they were rinsed off by saline before suturing the laceration wound. The rabbits were then killed after 3 days, 2 weeks and 4 weeks of healing and the lips were processed for histological evaluation. Similar normal histological healing patterns were seen in wounds in which EMLA and Oraqix were applied compared with control lacerations at all stages of healing. No adverse tissue or foreign body reactions were seen in any of the lacerations. We conclude that EMLA and Oraqix can be used in oral mucosal lacerations prior to suturing without the risk of adverse tissue reaction.

TRAUMATIC URINARY DIVERSION CAUSED BY GUNSHOT INJURY IN A STALLION

Summary A seven-year-old stallion with diversion of urinary pass to the thigh due to a urethral fistula caused by gunshot perineal injury was presented to the Urmia University, Veterinary Teaching Hospital. No signs of urinary obstruction or renal failure were observed. Because of inaccessible location of the injured urethra, through a perineal urethrotomy incision, a urinary catheter was effectively advanced to repel the obstruction into the bladder. Retrograde urethral catheterization was adopted for 5 days to assist mucosal healing. Healing was uneventful and no complications were observed during one month postoperative. Key words: Fistula, Urethra, Gunshot, Stallion Introduction The urethra, a muscular tube lined by mucosa, serves as the normal conduit for urine flow to the exterior of the body after birth. The male urethra connects the bladder to the glans penis and consists of pelvic and extrapelvic segments (Sisson and Grossman, 1975). Disorders of the equine penis and urethra that require surgery are principally limited to conditions involving urolithiasis, soft tissue obstructions, contusions, and lacerations (Trotter

Displacement of tooth fragments to the lower lip: a report of a case presenting an immediate diagnostic approach

Dentoalveolar injuries are common and are caused by many factors with falls accounting for the most frequent one. Dental trauma requires a special consideration when dental fractures accompany soft-tissue lacerations. Dental fragments occasionally penetrate into soft tissues and may cause severe complications. A thorough clinical examination with soft-tissue radiographs could provide an early diagnosis and surgical removal. This case report presents an immediate diagnosis and management of displaced tooth fragments to the lower lip following a dental trauma.

Tooth extraction complication and treatments at the Exodontia Clinic of the Oral and Dental Hospital of the Faculty of Dentistry of Universitas Padjadjaran Bandung

The patient’s dental conditions who visited the Exodontia Clinic of the Oral and Dental Hospital of the Faculty of Dentistry of Padjadjaran University, Bandung, were generally in a severe damage stage, causing problems in extraction. This condition, as well as the operator ’s (co-assistant student) that still have limited capability, may increase the risk of complication. This study was conducted at the Exodontia Clinic of the Oral and Dental Hospital of the Faculty of Dentistry of Padjadjaran University. It is conducted from March 13 to May 13, 2007. It is aimed at finding out the types of tooth extraction complications including the treatments towards the problems. This study was a prospective descriptive using the survey method. The study showed that there were 70 cases (64% ) of complications occurred, namely, 37 cases (6.68%) in the maxilla, and 33 cases (5.96% ) in the mandible. The complications that occurred consisted of root fracture (41 .43%), crown fracture (32.86% ), soft tissue laceration (14 .29%), maxillary sinus perforations (2.86% ), syncope (2.86% ), swelling (2.86% ), and secondary hemorrhage (2.86% ).

A Prospective Study Of Spinal Cord Injury In The University Of Calabar Teaching Hospital, Calabar, Nigeria: A Preliminary Report

Background: Spinal Cord Injury (SCI) is still a major cause of morbidity and mortality in our environment. It posses a management challenge to the Orthopaedic surgeons in an environment of scarce manpower and specialized facilities. Aim: To establish the pattern of SCI in Calabar and contribute to the existing national data on this injury as well as highlighting the deficiencies in our peculiar environment with a view to improving them. Methods: A prospective research protocol by questionnaire was designed for all patients presenting with spinal cord injury at the University of Calabar Teaching between February 2005 and January 2006. The parameters of study included patients' demographics, mode and pattern of injuries, neurologic grade pre and post treatment, complications and clinical outcome. Results: Fourteen spinal cord injured patients were admitted during the study period. Mean age was 36years with a male/female ratio of 4:1. Motor vehicle accidents were the most common cause 12 (85.7%). Thirteen (93%) patients were transported to the hospital by bus/car while one patient was brought on a motor cycle. None of the victims of road traffic accident wore protective device nor had any proper pre-hospital care. The commonest site of injury was the lumbar region 6 (43%) while cervical and thoracic regions contributed 5 (35.7%) and 3(21.4%) respectively. Clinical presentation were; paraplegia 11 (78.6%), quadriplegia 2 (14.3%) and spinal shock 1 (7%). Treatment included cast/braces support, drugs and Physiotherapy. Associated injuries included limb factures-4, head injuries-1, rib fractures-1, Splenic-1, bowel injuries-1 and soft tissue lacerations in 2 patients. Mean interval between injury and presentation at hospital was 2 days (2hrs-30days) while the duration of stay in hospital ranged between 4 to 20 weeks. Mortality was 2 (14.3%) Conclusion: Public enlightenment on road safety measures and use of proper protective devices including seat belts and helmet could reduce the high morbidity associated with Spinal cord injuries. More spinal centres and training of more trauma/neurosurgeons are needed.

Success in the Prevention of Infant Walker–Related Injuries: An Analysis of National Data, 1990–2001

Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States. A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries. An estimated 197200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23,000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20,900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases. The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries.

Epidemiology of Weight Training Equipment–Related Injuries to Young Children in the Home

ABSTRACTThe objective of this study was to describe and identify the type, cause, and epidemiology of injuries related to weight training equipment (WTE) to children under 5 reported to U.S. emergency rooms. Methods included a retrospective review of data for children 4 years old and younger from the National Electronic Injury Surveillance (NEISS) system of the U.S. consumer Product Safety Commission for the years 1994–2001. A total of 893 children were identified who obtained treatment at a participating emergency room. Results indicated there were an estimated 28,873 WTE-related injuries (95% CI [CI]: 23,194–34,552) to children 4 years old and younger treated in hospital emergency departments in the United States during the 8-year study period. The annual rate of injury among children was 15.97 per 100,000. Most injuries involved the foot, head, and hand regions. Injury diagnosis included soft tissue injuries (38%), lacerations (35%), and fractures and dislocations (20%). Most hospital admissions were f...

Injuries due to seizures in persons with epilepsy

Previous studies of injuries due to epileptic seizures predominantly involved patients with intractable epilepsy. These studies may have overestimated the risk of injuries in persons with epilepsy. Patients consisted of 247 Rochester, MN, residents who were diagnosed with epilepsy between 1975 and 1984. Seizure-related injuries were defined as any injury, other than orolingual trauma, resulting from a seizure, sufficient for the patient to seek medical attention or for injury occurrence to be determined during the course of medical care. To identify risk factors for injury, characteristics of patients with seizure-related injury were compared with those without injury. During a total of 2,714 patient-years of follow-up, 62 seizure-related injuries were identified in 39 patients (16%, one injury in every 44 person-years). Most injuries involved cranial soft tissue contusions or lacerations (79%). The majority of seizure-related injuries (82%) occurred during generalized convulsive seizures. Univariate analyses identified five potential risk factors for seizure-related injury: greater number of antiepileptic drugs used, less independent living situation, higher Rankin score, history of generalized convulsive seizures or drop attacks, and higher seizure frequency score. Seizure frequency, however, was the only significant risk factor identified by multivariate analysis (p < 0.001; relative risk, 1.33). This population-based study shows that seizure-related injuries are infrequent and generally of minor severity. In most epilepsy patients, excessive restriction of daily activities to avoid injury is unnecessary. Effective seizure control reliably reduces the risk of seizure-related injuries.

Descriptive epidemiology of a cluster of hand injuries from snowblowers

The objective of the study is to describe the nature and type of snowblower-related hand injuries, including long term follow up. A retrospective study was performed of a cluster of patients injured by snowblower use, presenting to an urban Emergency Department (ED) following a major snowstorm. For each patient, demographic data and subsequent records from outpatient management were reviewed. Interviews were conducted 3 years later to assess long-term outcomes. Eleven patients, all male, presented to the ED with snowblower injuries, all to the hand. Injuries included soft tissue lacerations and partial to complete amputations. Ten patients were treated and released and one was admitted. In a 3 year follow-up, few patients reported major sequela. Almost half reported persistent pain, or minor disability. In conclusion, in our series, snowblower injuries resulted exclusively in trauma to the hand. Most injuries can be managed on an outpatient basis. Many patients experience persistent symptoms. All patients had entirely preventable injuries.

The MCFONTZL Classification System for Soft-Tissue Injuries to the Face

A review of the literature and case records reflected a need for the development of a clinically applicable assessment scheme and classification system for soft-tissue laceration injuries to the face. Herein, a systematic approach for assessing facial lacerations is proposed based on location, depth of penetration, branching, directionality, size, presence of soft-tissue defect, and translation of such injuries into the current procedural terminology (CPT) code. Moreover, a new classification system for facial laceration injuries is presented that may serve as the basis for simplification of current billing codes. Prospective clinical application of this classification system may lead to standardization of facial injury assessment and improvement in the incomplete and inconsistent patient record. This system will establish a reliable database that may identify factors in soft-tissue injuries that contribute to poor aesthetic results or secondary functional deformities. These data will lead to the modification of established treatment plans. (Plast. Reconstr. Surg. 103: 1150, 1999.)

The MCFONTZL classification system for soft-tissue injuries to the face.

A review of the literature and case records reflected a need for the development of a clinically applicable assessment scheme and classification system for soft-tissue laceration injuries to the face. Herein, a systematic approach for assessing facial lacerations is proposed based on location, depth of penetration, branching, directionality, size, presence of soft-tissue defect, and translation of such injuries into the current procedural terminology (CPT) code. Moreover, a new classification system for facial laceration injuries is presented that may serve as the basis for simplification of current billing codes. Prospective clinical application of this classification system may lead to standardization of facial injury assessment and improvement in the incomplete and inconsistent patient record. This system will establish a reliable database that may identify factors in soft-tissue injuries that contribute to poor aesthetic results or secondary functional deformities. These data will lead to the modification of established treatment plans.

A one-year review of maxillofacial sports injuries treated at an accident and emergency department

To assess the aetiology and demand for oral and maxillofacial surgery services associated with sports injuries, a prospective study was undertaken. Data were collected from consecutive patients (with maxillofacial injuries associated with sports) attending the accident and emergency department at the Cardiff Royal Infirmary in the UK during a 12-month period and analysed. Data relating to demography, aetiology, site and extent of injury, treatment and outcome were collected. There were 790 attendances (695M: 85F) arising principally from injuries related to rugby ( n = 206), cycling ( n = 189) and football ( n = 109) but few from recognized contact sports ( n = 26). The principal causes of these injuries were direct bodily contact ( n = 260) and falls ( n = 219). The commonest injury was soft-tissue laceration ( n = 604); 80 patients had dentoalveolar fractures and 64 patients had fractures of the facial skeleton. Injuries were located in the upper- ( n = 257), middle- ( n = 201) and lower third of the face ( n = 124) with 188 lip/intraoral injuries. Repair of lacerations ( n = 600) was the commonest treatment; only 46 fractures required interventive treatment. Follow-up was performed for most of these patients at the Department of Oral and Maxillofacial Surgery at the Dental Hospital ( n = 404) and general medical/dental practitioners ( n = 258). These data highlight the importance of oral and maxillofacial surgery staff in the management of sports injuries in accident and emergency departments. Moreover, they suggest the need for prioritization of rule and legislation changes and the continuing need to improve safety standards to prevent maxillofacial injuries.

Catastrophic Falls in Patients Who Have Fibrodysplasia Ossificans Progressiva

There have been numerous anecdotal reports of catastrophic falls in patients with fibrodysplasia ossificans progressiva. To determine the incidence of serious morbidity and mortality associated with falls in this patient population, the authors surveyed the 135 patient members of the International Fibrodysplasia Ossificans Progressiva Association and an age and gender matched control group. Eighty-one percent of the fibrodysplasia ossificans progressiva population suffered a fall resulting in injury compared with 44% of the controls. Sixty-seven percent of the falls initiated a painful flareup of fibrodysplasia ossificans progressiva leading to permanent loss of movement in almost all patients. Fifty-four percent of all falls suffered by the fibrodysplasia ossificans progressiva group led to permanent disability compared with 4% of all falls in the control group. Although trauma to the head was a common site of injury in both groups, the injury profile in the fibrodysplasia ossificans progressiva group included traumatic brain injuries, intracranial hemorrhage and death whereas the control group suffered mostly minor soft tissue lacerations. Deficiencies in coordinate gait and protective function likely accounted for the severity of injuries especially to the head in the fibrodysplasia ossificans progressiva population. Precautions are recommended that are intended to minimize the risk of injury without compromising a patient's functional level and independence. These recommendations include limitation of high risk activities, protective head gear, safety improvements in living environments, and augmentation of stabilizing and protective functions.

Suture repair of soft tissue lacerations.

Suture repair of soft tissue lacerations.

Suture Repair of Soft Tissue Lacerations

Suture Repair of Soft Tissue Lacerations

Are antibiotics necessary in the surgical management of upper limb lacerations?

Previous research has shown that antibiotic usage in patients with superficial sharp lacerations has no influence over infection rate. This study is a prospective controlled trial, using systematic allocation, of 250 patients of which 113 received co-amoxiclav (Augmentin) and 137 did not. Special emphasis was placed on wound debridement and irrigation. All sharp soft tissue lacerations including those with nerve, tendon and muscle damage were entered into the trial. The results show a low overall infection rate of 4%. The infection rate in the group treated with antibiotics was 5% and 3.2% in the group who received no antibiotics. Lacerations operated on up to 48 h from the injury were included and there was no correlation between the length of time waited and the infection rate. We conclude that antibiotics are an unnecessary adjunct in the treatment of sharp lacerations of the hand and upper limb, provided meticulous surgical debridement is performed.

Patterns of Facial Laceration from Blunt Trauma

The clinical characteristics of craniofacial injuries resulting from various modes of blunt trauma, including motor vehicle accidents, falls, and assault, have been described extensively in the literature. In this study, specifically targeted blunt trauma to selected areas of the face was used to recreate soft-tissue laceration injuries on 19 cadaver heads. The patterns of laceration produced were then examined by location, size, penetrated skin depth, and associated muscle and bony involvement. Results showed reproducible patterns of lacerations on the forehead, bilateral superior orbital rim, nose, perimaxillary region, and chin. Six of 19 cadaver faces were undermined prior to blunt trauma to determine the effects of subcutaneous attachments on laceration patterns. Results showed no consistent difference in laceration patterns between undermined skin and intact skin. Our findings suggest that in response to blunt trauma, the skin breaks along selected lines of least resistance that closely parallel cleavage lines of the face and that the patterns of laceration generated are associated with inherent structural and biomechanical properties of the skin, independent of subcutaneous attachments. Blunt trauma lacerations to the face therefore may occur in a consistent and reproducible manner and may be subject to classification.