Patients admitted for treatment of traumatic finger amputations: Characteristics, causes, and prevention.

BACKGROUND: The aim of this study was to analyze the epidemiology of patients admitted with finger amputations in the U.S., as well as to evaluate and propose prevention strategies. METHODS: The National Electronic Injury Surveillance System was queried to obtain data on patients that presented to, and were admitted from US emergency departments for treatment of traumatic finger amputations during the period of 2002-2016. The Haddon Matrix, a framework that can be used to analyze the host, agent, and environmental factors of an injury relative to its timing, was then used to evaluate possible contributing factors of amputation events, and thereby explore plausible prevention interventions. RESULTS: From 2002 to 2016, approximately 348,719 people were admitted from the ED for traumatic amputations. The majority were Caucasian and were male. The mean age was 42.3 years old. This was significantly older than those who were not admitted. The top five products responsible for amputations in admitted patients were power saws (40.9% of cases), doors (10.3%), lawn mowers (7.4%), snow blowers (4.3%), and bicycles (2.4%). This list included a higher proportion of powered tools than those with finger amputations who were discharged from the ED with a finger amputation. CONCLUSION: Patients admitted with finger amputations from the ED were older, more likely to be male, and more likely to be victims of powered tools than those that were discharged. Table saws are responsible for a high proportion of the finger amputations that result in hospital admissions. The Haddon Matrix helps us identify factors (host, agent, physical environment, and social environment) to be addressed in prevention strategies. Such approaches might include championing education campaigns, policy measures, and equipment safety features. The effectiveness of such strategies warrants further investigation.

Component Separation Technique for Repair of Massive Abdominal Wall Defects at a Pediatric Hospital.

BACKGROUND: Massive defects of the abdominal wall are commonly repaired with the component separation technique (CST) when insufficient tissue exists to close the defect primarily. Although the utility of CST has been documented in cases of large ventral hernias in adults, its application to congenital and acquired defects in pediatric patients has been largely unreported. This study is a retrospective case series discussing the success of CST at a large pediatric hospital. METHODS: Seven patients with massive abdominal wall defects, including ventral hernia and omphalocele, repaired with CST at a pediatric hospital were identified as candidates. Patient records were reviewed for relevant history, cause of ventral hernia, surgical repair using CST with or without tissue expansion (TE), use of mesh, postoperative complications, and length of follow-up. RESULTS: Seven patients, 4 with omphalocele and 3 with acquired ventral hernia, were successfully treated with CST. Median patient age at the time of CST was 7 years (range, 3-19 years) with a mean defect diameter of 10.1 cm (range, 5-12 cm). Four patients underwent TE before component separation. Recurrent ventral hernia required reoperation with CST in 2 cases. Mean follow-up was 2 years and 9 months (range, 13 months-6 years). CONCLUSIONS: Component separation technique is a valuable method for abdominal wall reconstruction in pediatric patients with low risk of serious complication. This technique can be augmented with TE and mesh placement to address lack of available soft tissue or other operative challenges.

Nodular Basal cell carcinoma arising in a split-thickness skin graft of the scalp.

We present the first known case of basal cell carcinoma arising in a split-thickness skin graft in the United States. The apparent low incidence of basal cell carcinoma in split-thickness skin graft attests to its unique environment and could possibly be attributed to the following: (1) the donor sites for split-thickness skin grafts are usually areas that are not subjected to heavy sun exposure; (2) individuals with skin grafts may not live as long on average, or their skin grafts may be subsequently excised with further reconstructive procedures; and (3) cases may be underreported. Because basal cell carcinomas have a fairly benign course, many patients either do not present to a physician or are not reported. This case shows that a split-thickness skin graft can have an adequate microenvironment for the development of basal cell carcinoma.