Left knee septic monoarthritis in a pediatric patient due to shewanella putrefaciens: case report and literature review.

BACKGROUND: Shewanella putrefaciens is a gram-negative, nonfermenting, oxidase-positive, hydrogen sulfide-producing bacillus and a halophilic bacterium, known for causing unusual infections in humans and often regarded as an opportunistic pathogen. Its diverse symptoms have a significant impact on human health, with 260 documented disorders reported in the literature over the last 40 years, highlighting its potential danger. CASE PRESENTATION: We present the case of a previously healthy 15-year-old male patient who sustained a self-inflicted sharp-object injury while working in the field, resulting in secondary septic monoarthritis due to Shewanella putrefaciens. CONCLUSIONS: This case highlights the bacteriological and clinical characteristics, as well as the antibiogram, of Shewanella spp. Given the recent increase in notifications of Shewanella infections, predominantly by S. algae and S. putrefaciens, it is essential to consider these pathogens in patients with a history of contact with bodies of water. Special attention must be paid to their resistance patterns in patient management to prevent the development of intrinsic antimicrobial resistance.

A modified chain-based sponge dressing controls junctional hemorrhage in the tactical combat casualty care simulation of pigs.

BACKGROUND: Hemorrhage has always been the focus of battlefield and pre-hospitalization treatment. With the increasing fatality rates associated with junctional bleeding, treatment of bleeding at junctional sites has gradually gained attention in battlefield trauma emergency care. We designed a modified chain-based sponge dressing with a medical polyvinyl alcohol sponge that can be used to treat junctional hemorrhage and tested its hemostatic efficacy and biocompatibility. METHODS: Twenty adult Bama miniature pigs were randomly divided into the modified chain-based sponge dressing (MCSD) and standard gauze (SG) groups. The right femoral artery of the pigs was shot at after anesthesia. The Bama miniature pigs were moved to the safety zone immediately to assess the condition according to the MARCH strategy, which evaluates massive hemorrhaging, airway obstruction, respiratory status, circulatory status, head injury & hypothermia. Hemoglobin and coagulation status were checked during the experiment.Among the pigs in which the inguinal hemorrhagic model based on bullet penetrating wounds was successfully established, those in the MCSD group received a disinfected MCSD for hemostasis, while those in the SG group received standard gauze in an imbricate manner to pack the bullet exit and entrance wounds to stop bleeding until the wound was filled, followed by compression for 3 min at sufficient pressure. CT scanning, transmission electron microscopy, and HE staining were conducted after experiment. RESULTS: The MCSD group showed lower hemostasis time and blood loss than the gauze group. The MCSD group also showed a higher success rate of treatment,more stable vital signs and hemoglobin level. The CT scanning results showed tighter packing without large gaps in the MCSD group. The histopathological assessments and the transmission electron microscopy and HE staining findings indicated good biocompatibility of the polyvinyl alcohol sponge. CONCLUSION: The MCSD met the battlefield's requirements of speedy hemostasis and biosafety for junctional hemorrhage in Bama miniature pigs. Moreover, in comparison with the conventional approach for hemostasis, it showed more stable performance for deep wound hemostasis. These findings provide the theoretical and experimental basis for the application of MCSD in the treatment of hemorrhage in the battlefield in the future.

Tratamiento combinado de Espongostan® y Mepitel® en heridas con pérdida de sustancia y abundante sangrado / Combined treatment of Espongostan® and Mepitel® in wounds with loss of substance and abundant bleeding: a case series

Objetivo: Las heridas por pérdida de sustancia en las yemas de los dedos son dolorosas, incapacitantes y sangran abundantemente. El tratamiento recomendado es a base de Espongostan®, aunque este producto puede combinarse con Mepitel®. La combinación de ambos tratamientos podría reducir el dolor y minimizar el sangrado en curas sucesivas. El objetivo de este estudio es describir la aplicación del tratamiento combinado de Espongostan® y Mepitel®. Además, se describirá la evolución del dolor y el sangrado en estos pacientes. Descripción del caso: Se aplicó el tratamiento combinado a 6 pacientes con heridas de pérdida de sustancia en las yemas de los dedos. Resultados: La escala EVA se mantuvo en valores moderados o se redujo a leve en curas sucesivas. Los pacientes no describen signos de dolor destacables al retirar el Espongostan®. Por otro lado, el sangrado remitió antes de 8 días. La tasa promedio de remisión del sangrado se situó en 1 caso por 4 días. Conclusión: La cura combinada es altamente positiva para minimizar el dolor y el sangrado, reduciendo por consiguiente las molestias derivadas sobre los pacientes. (AU)

Objective: Loss of substance wounds on the pads of the fingers are painful, disabling, and have profuse bleeding. The recommended treatment is based on Espongostan®, although this product may be combined with Mepitel ®. The combination of both treatments could reduce pain and minimize bleeding in successive cures. The objective of this study is to describe the application of the combined treatment of Espongostan® and Mepitel®. In addition, the evolution of pain and bleeding in these patients will be described. Description of the case: We applied the combined treatment to 6 patients with loss of substance wounds on the pads of the fingers. Results: The VAS scale remained at moderate values or was reduced to mild in successive cures. Patients do not describe noticeable signs of pain when removing the Espongostan®. Bleeding subsided before 8 days. The average bleeding remission rate was 1 case per 4 days. Conclusion: The combined cure is highly positive for minimizing pain, bleeding and reducing discomfort caused to patients. (AU)

Iliopsoas Hematoma and Abscess Formation as a Complication of an Anterior Abdominal Penetrating Injury: a Case Report and Review of Literature.

Background: Abdominal stab wounds are common in clinical practice. However, the development of psoas muscle abscess following such an injury is extremely rare. Moreover, literature surrounding psoas muscle hematoma formation as a consequence of penetrating abdominal injury is scarce. Objective: We report a case of psoas abscess formation following the development of psoas hematoma in a patient who suffered from a penetrating abdominal injury. Case presentation: A 40-year-old Indian male presented to the Emergency department with multiple abdominal cut and stab wounds as a result of physical assault. A computed tomography scan revealed injuries to the ascending colon along with hemoperitoneum and right psoas muscle hematoma. Exploratory laparotomy was performed in which a right hemicolectomy and a right psoas muscle evacuation were successfully achieved along with multiple drainage tubes placed. Six days later, a peritoneal fluid culture tested positive, and a computed tomography scan revealed right psoas muscle collection which was diagnosed as an abscess. Treatment of the abscess included antibiotics and ultrasound-guided drainage. Patient was eventually discharged but was lost to follow-up. Conclusion: The development of iliopsoas abscess and hematoma as a consequence of abdominal penetrating injuries is a rare occurrence. Diagnosis can be made by computed tomography imaging and examination of the drained fluid. Managing a case with both of these rare phenomena can be challenging due to the scarce literature highlighting and comparing the different management modalities.

Water-Swellable Cellulose Nanofiber Aerogel for Control of Hemorrhage from Penetrating Wounds.

Uncontrolled hemorrhage from wounds with deep and irregular cavities is short of efficient hemostats. Here we report a citric acid-cross-linked carboxymethyl cellulose nanofiber (CA-CMCNF) aerogel for the control of bleeding from penetrating wounds. The compressed CA-CMCNF aerogel could quickly swell into its original shape in water in seconds. The maximum mass and volume expansion ratios were over 6800 and 3000%, respectively. The water-swellable property allows the aerogel to self-expand and fill in the cavities of wounds. The in situ-generated expansion pressure resisted the systolic blood pressure, and the plentiful carboxyl groups triggered the active coagulation pathway, both contributing to the hemostatic capability of the aerogel. Additionally, the aerogel had good biocompatibility and excellent antibacterial capability. The animal experiments revealed that the aerogels significantly reduced both the hemostasis time and the amount of bleeding in a liver penetrating model. Therefore, this study provides a safe and robust hemostatic aerogel for controlling bleeding from penetrating wounds.

Pre-operative Ultrasound Localization for Removal of a Penetrating Foreign Body of Forearm: Technical Note.

Retained or missed foreign bodies are a common complication associated with penetrating wounds. Ideal management includes immediate removal of the foreign material without any further damage to local tissues. However, removal is often difficult if the foreign body is small or has penetrated deeply. In this setting, the emergency room is a suboptimal environment for removal. Ultrasound utilized at the time of removal improved our ability to localize the foreign body, however this requires surgeon familiarity with the equipment. We describe the use of preoperative ultrasound guided foreign body localization with careful topographic skin marking to guide intraoperative foreign body removal with increased yield and obviating the need for ultrasound at the time of removal.

[Functional outcomes of penetrating eye injuries in children]. / Funktsional'nye iskhody pronikayushchikh ranenii glaznogo yabloka u detei.

Open wounds of the eye are the most common ocular injuries in children in Tajikistan. Assessment of visual functions in the outcome of such wounds is the most important task for developing a rehabilitation plan and predicting the prospects for the recovery of vision, especially in young patients. OBJECTIVE: To assess visual acuity (VA) in the outcome of a penetrating wound of the eyeball in children. MATERIAL AND METHODS: The study retrospectively analyzed VA in the outcome of type B open trauma of scleral (12.1%), corneal (59.1%), and scleral-corneal (28.8%) localization in 132 children (132 eyes) older than 4 years (mean age 8.3 years), who were admitted to the hospital on the first day after injury. The exclusion criteria from the main selection were: the presence of an intraocular foreign body, the age of patient higher than 4 years old, and the time of admission more than 24 hours post the moment of injury. RESULTS: Visual acuity was checked at the time of discharge from the hospital (average stay was 19.02 days) and amounted to 0-light projection in 50 (37.9%) children; 0.01-0.1 in 43 (32.6%); 0.2-0.3 in 29 (22.0%); above 0.4 in 10 (7.6%). High rate of vascular reactions to trauma was noted on admission on the first day - intraocular hemorrhage (28.8%), hyphema (10.6%), endophthalmitis (5.3%) as a result of a penetrating injury to the eyeball - as well as their negative effect on vision at discharge. CONCLUSION: Upon discharge from the hospital, in 92.4% of children the visual acuity in the outcome was 0.3 and below. Adverse visual outcomes significantly correlated with the depth of the injury (correlation coefficient 0.5931) and vascular reactions to trauma (correlation coefficient 0.503333).

Reconstruction of extra-large severe punching hole injury in the palm: A case report.

A 48-year-old man sustained a severe punching hole injury of 8 cm in diameter on the palm of his left hand using a punching instrument (for making the bottom of drink cans), and his middle and ring fingers were almost amputated. A flow-through type immediate ALT (anterolateral thigh) flap was used to bypass the distal blood flow and a titanium plate for mandibular reconstruction and plantar glabrous skin were used to preserve the floating amputated fingers. As there has been no report of reconstruction of a punching hole in the palmar region that exceeds 8 cm in diameter, this report is novel and educational.

The use of a Foley balloon catheter to control junctional hemorrhage in a dog with severe vascular injury secondary to penetrating trauma.

INTRODUCTION: Penetrating trauma is commonly seen in dogs. The severity depends on the site of injury and tissue involved. Junctional hemorrhage can be especially challenging to control given the inaccessibility of the damaged vasculature. Methods described to control life-threatening hemorrhage in dogs include direct pressure, hemostatic gauze, hemostatic powder or granules, wound packing, tourniquets, and direct clamping of the vasculature. Foley balloon catheters (FBC) are commonly used to tamponade deep vascular hemorrhage in people, but the technique has not been previously described in the veterinary literature. OBJECTIVE: To present a case of penetrating trauma (bite wound) in a dog with a transected left femoral artery and vein in which the life-threatening hemorrhage was initially controlled with tamponade using an FBC. CASE: A 7-year-old neutered male Terrier mix presented in hemorrhagic shock with an Animal Trauma Triage (ATT) of 7 and modifed Glasgow coma scale (MGCS) of 17 forty-five minutes after being attacked by another dog. The dog had sustained a deep penetrating wound to the left groin. Direct pressure and gauze packing at the site of injury were not successful at slowing the hemorrhage. A 10-Fr, 55-cm Foley catheter with a 5-mL balloon was inserted into the wound tract, and the balloon was inflated with 7.5 mL of sterile saline. Hemorrhage was controlled after inflation of the Foley balloon. CBC, blood biochemistries, abdominal point-of-care ultrasound, radiographs, prothrombin time, partial thromboplastin time, and whole blood viscoelastic testing were performed. Stabilization included fluid resuscitation, analgesics, antimicrobials, and epsilon aminocaproic acid. The dog was then anesthetized to definitively identify and control the hemorrhage. Transection of the left femoral artery and vein where identified and ligated. The dog fully recovered and was discharged 32 hours later. NEW AND UNIQUE INFORMATION: FBCs may be useful as an alternative technique for temporary control of life-threatening hemorrhage secondary to penetrating injuries in both the emergency department and prehospital settings.

Outcomes of open neck injuries.

Purpose: The neck is a particularly critical region for penetrating injuries due to the close proximity of the trachea, esophagus, blood vessels, and the spinal cord. An open neck injury has the potential for serious morbidity and mortality. The purpose of this study is to evaluate the assessment and management of open neck injuries. Methods: In this retrospective study, open neck injury patients who were admitted to the Trauma Center of Daejeon Eulji Medical Center, Eulji University between December 2015 and December 2017 were analyzed for epidemiology, the mechanism of trauma, the injured organ, complications, and mortality. Results: Thirty-two patients presented with open neck injuries. All patients underwent computed tomographic angiography to evaluate their injuries once their vital signs stabilized. Among these patients, 27 required surgical treatment. The most commonly injured organ was the airway. There were five deaths, and the main cause of death was bleeding. Mortality was associated with the initial systolic blood pressure at the hospital and Glasgow Coma Scale. Conclusions: Mortality from open neck injuries was associated with initial systolic blood pressure at the hospital and Glasgow Coma Scale.

Penetrating Spinal Cord Injury in civilians: analysis of a national database.

BACKGROUND: Spinal trauma is common in polytrauma; spinal cord injury (SCI) is present in a subset of these patients. Penetrating SCI has been studied in the military; however, civilian SCI is less studied. Civilian injury pathophysiology varies given the generally lower velocity of the projectiles. We sought to investigate civilian penetrating SCI in the United States. METHODS: We queried the National Inpatient Sample for data regarding penetrating spinal cord injury from the past 10 years (2006-2015). The National Inpatient Sample includes data of 20% of discharged patients from U.S. hospitals. We analyzed trends of penetrating SCI regarding its diagnosis, demographics, surgical management, length of stay, and hospital costs. RESULTS: In the past 10 years the incidence of penetrating SCI in all SCI patients has remained stable with a mean of 5.5% (range 4.3%-6.6%). Of the patients with penetrating SCI, only 17% of them underwent a surgical procedure, compared with 55% for nonpenetrating SCI. Patients with penetrating SCI had a longer length of stay (average 23 days) compared with nonpenetrating SCI (15 days). Hospital charges were higher for penetrating SCI: $230,186 compared with $192,022 for closed SCI. Males patients were more affected by penetrating SCI, as well as black and Hispanic populations compared with whites. CONCLUSIONS: Penetrating SCI represents 5.5% of all SCI patients. Men, blacks, and Hispanics are disproportionally more affected by penetrating SCI. Patients with penetrating SCI have fewer surgical interventions, but their overall length of stay and hospital costs are greater compared with nonpenetrating SCI.

Penetrating neck trauma: radiological predictors of vascular injury.

PURPOSE: Vascular injury in penetrating neck trauma predicts a poorer outcome and usually requires surgical neck exploration. Multi-detector computed tomography (MDCT) angiography is a readily available non-invasive diagnostic tool that can identify direct and indirect signs of vascular injury in stable patients. This study aims to investigate the diagnostic accuracy of radiological signs of vascular injury on MDCT, and their implications on patient management in the setting of penetrating neck trauma. METHODS: A retrospective cohort study of penetrating neck injuries (PNI) between 2012 and 2018 in a UK major trauma centre was performed. Clinical data and operative findings were compared with radiological findings on MDCT performed at the time of admission. RESULTS: 157 patients were identified with PNI in the study period, with 67 meeting inclusion criteria. The predictive value of indirect radiological signs of vascular injury alone was low, with only 12.1% of these patients having significant vascular injury found at neck exploration. However, the combined use of direct radiological signs with clinical signs resulted in a specificity of 97.7% for vascular injury. CONCLUSIONS: The use of direct and indirect radiological signs of vascular injury can increase the accuracy of diagnosis when used in conjunction with clinical signs. Combining clinical assessment and radiological investigation, specifically contrast-enhanced MDCT, improves the specificity in pre-operative assessment of potential vascular injury in PNI. MDCT is recommended in stable patients with clinical signs of vascular injury to reduce the rate of negative neck exploration.

Reconstruction of complicated through-and-through cheek defects with multiple-paddled anterolateral thigh flap / 中华整形外科杂志

Objective@#To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction.@*Methods@#From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types.@*Results@#All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease.@*Conclusions@#The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed.

An Unforeseeable Complication; Posterior Ischemic Optic Neuropathy after Penetrating Injury to the Heart.

Trauma surgeons are currently encountering unusual adverse events after traumatic injuries. Ischemic optic neuropathy is a rare complication that may occur in trauma and burn patients that present in extremis and require massive resuscitation. A 29-year-old male patient sustains a penetrating injury to the heart that required primary repair. He remained hemodynamically stable and required a limited amount of resuscitative fluids and products. Postoperatively, the patient develops acute painless bilateral loss of vision. These findings were consistent with posterior ischemic optic neuropathy. Ischemic optic neuropathy are uncommon entities that arise in trauma patients who require massive resuscitation. Given the limited treatment options, early diagnosis is key in limiting the hemodynamic insult to the optic nerve.

A shark attack treated in a tertiary care centre: Case report and review of the literature.

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

A shark attack treated in a tertiary care centre: Case report and review of the literature

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

Repairment of skin defects of penetrating palm wound by application of free string-type dorsalis pedis flap and anterior malleolus flap / 中华显微外科杂志

Objective To investigate the clinical outcome of the feasible method of the free string type dor salis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm.Methods From May,2011 to January,2017,the anterior combined ankle flap of the ankle were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases survived.Follow-up were done from 2 months to 2 years after operation.Bone healing was achieved in all cases.Two-point discrimination recovered to 6-8mm.Total active range of motion of the fingers reached 75 ％ of the normal side.Both appearance and texture of the flaps were good.Both the appearances of the repaired palms and the functional recovery were satisfactory.The function assessment of the hand was excellent in 8 cases,good in 5 cases,fine in 2 cases and poor in 1 case.The eligible rate was 81.25 ％.Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant,which facilitate the dissection of the flaps during operation.The repairement of skin defects at two sides,both the palm and the back of hand,can be achieved via one operation.Therefore,the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.

Severing of skull cap: A rare trauma attributed to transportation of bulldozer.

Bulldozer fatalities are usually due to accidental crushing of the body at the workplace. However, severance of the skull cap simulating a chopping injury to head is rare in the literature. Medico-legal investigation may be posed with different challenges when carrying out an autopsy of a victim with this devastating head injury. The police will seek an opinion about the type of weapon responsible for the injuries, the nature of injuries produced and manner of death. In the present case, the victim was hit at dusk by a protruding part of the bulldozer blade as he crossed in front of a bulldozer that was approaching his tractor from the opposite side of the road. His skull cap was severed and he died instantly. This report considers the circumstances of his death, its mechanisms and strategies for preventing such deaths.