RESUMO
Amputations associated with fireworks are customarily treated by stump revision resulting in permanent disability. In this case report, we present an eight-year old boy who suffered an amputation of his right distal index finger at the level of the epiphyseal disk with degloving injury of the amputated finger caused by fireworks. Successful re-implantation was achieved. Two-year follow-up revealed fair cosmesis and acceptable functional and aesthetic recovery though the free distal phalanx had been absorbed completely. Re-implantation of a degloving amputation finger caused by fireworks is possible and can provide good distal soft tissue coverage and recovery ofsensory and motor functions.
Las amputaciones relacionadas con fuegos artificiales son tratadas habitualmente por revisión de muñón, lo que trae como resultado una discapacidad permanente. En este reporte de caso, presentamos a un niño de 8 años que sufrió una amputación de su dedo índice derecho distal a nivel del disco epifisario con lesión por desguantamiento del dedo amputado causada por fuegos artificiales. Se logró una re-implantación exitosa. Los dos años de seguimiento revelaron una corrección quirúrgica cosmética satisfactoria, así como una recuperación funcional y estética aceptable, aunque la falange distal libre había sido absorbida completamente. La re-implantación de un dedo amputado por desguantamiento causado por fuegos artificiales es posible y puede proporcionar buena cobertura de tejido suave distal y recuperación de las funciones sensoriales y motoras.
Assuntos
Humanos , Masculino , Criança , Reimplante/métodos , Traumatismos por Explosões/cirurgia , Traumatismos dos Dedos/cirurgia , Amputação Traumática/cirurgia , Traumatismos por Explosões/fisiopatologia , Radiografia , Força da Mão , Explosões , Traumatismos dos Dedos/fisiopatologia , Traumatismos dos Dedos/diagnóstico por imagem , Férias e Feriados , Amputação Traumática/diagnóstico por imagemRESUMO
Amputations associated with fireworks are customarily treated by stump revision resulting in permanent disability. In this case report, we present an eight-year old boy who suffered an amputation of his right distal index finger at the level of the epiphyseal disk with degloving injury of the amputated finger caused by fireworks. Successful re-implantation was achieved. Two-year follow-up revealed fair cosmesis and acceptable functional and aesthetic recovery though the free distal phalanx had been absorbed completely. Re-implantation of a degloving amputation finger caused by fireworks is possible and can provide good distal soft tissue coverage and recovery of sensory and motor functions.
Assuntos
Amputação Traumática/cirurgia , Traumatismos por Explosões/cirurgia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Reimplante/métodos , Amputação Traumática/diagnóstico por imagem , Traumatismos por Explosões/diagnóstico por imagem , Traumatismos por Explosões/fisiopatologia , Criança , Explosões , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/fisiopatologia , Força da Mão , Férias e Feriados , Humanos , Masculino , RadiografiaAssuntos
Pessoal de Saúde/educação , Saúde da População Urbana , Ferimentos por Arma de Fogo/terapia , Traumatismos por Explosões/reabilitação , Traumatismos por Explosões/cirurgia , Traumatismos por Explosões/terapia , Cuidados Críticos , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Cooperação Internacional , América Latina , México , Cuidados Pós-Operatórios , Cruz Vermelha , Violência , Ferimentos por Arma de Fogo/reabilitação , Ferimentos por Arma de Fogo/cirurgiaRESUMO
BACKGROUND: To describe surgical management and establish anatomic and visual results of patients with explosive ocular trauma in terrorist attacks treated with extreme vitreoretinal surgery. METHODS: Retrospective study of clinical records (6-month follow-up) of patients with visual acuity (VA) of light perception or better with posterior segment injuries [vitreous hemorrhage, retinal detachment (RD), intra-ocular foreign bodies (IOFB), perforating trauma (PT)] from explosive weapons who underwent vitreoretinal surgery. We reviewed the demographic characteristics, type of weapon, time between injury and surgery, VA at arrival and 6 months after surgery, and type of trauma according to the International Trauma Classification. RESULTS: Fifty-seven out of 236 patients with ocular injuries from explosive weapons were included in the study; all of them were military men, average age 22 years (range 16-53 years). The average time between the blast and primary closing was 1 day, and 10 days between primary closing and vitreoretinal surgery. Open traumas by laceration accounted for 96% of cases and 4% were closed traumas; 76% of the eyes had IOFB, of which 18% involved PT; 5% had endophthalmitis. Contusion was the diagnosis for 100% of the closed traumas. Of the open traumas, 40% were localized at zone I, 44% at zone II, and 16% at zone III. Upon arrival, 98% of patients had VA 20/800-LP and 2% had >20/40. The patients with closed trauma had the injuries at zone III and presented VA 20/800-LP. All patients underwent posterior vitrectomy, scleral buckling, endotaponade and when required, lensectomy (82%), IOFB removal (72%), and/or retinectomy (25%). Postoperative VA improved in 43% of the patients, stabilized in 41% and evolved to NLP in 15% of the cases. Initial expressions of ocular trauma such as RD, PT and endophthalmitis suggest bad prognosis. CONCLUSIONS: We presented a series of patients with severe ocular trauma of the posterior segment from explosive weapons. These patients were treated according to our surgical protocol with extreme vitreoretinal surgery within the first 2 weeks after the blast; with our procedure we obtained stabilization or improvement of the VA for 84% of the cases.
Assuntos
Traumatismos por Explosões/cirurgia , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Militares , Descolamento Retiniano/cirurgia , Terrorismo , Hemorragia Vítrea/cirurgia , Adolescente , Adulto , Traumatismos por Explosões/etiologia , Colômbia , Substâncias Explosivas , Corpos Estranhos no Olho/etiologia , Ferimentos Oculares Penetrantes/etiologia , Humanos , Cristalino/cirurgia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Recurvamento da Esclera , Acuidade Visual , Vitrectomia , Hemorragia Vítrea/etiologia , GuerraRESUMO
Las lesiones musculoesqueléticas masivas causadas por la acción de la onda expansiva constituyen eventos graves para el paciente que las recibe y difíciles para el médico que las atiende. Se incluyeron aspectos sobre la fisiopatología de las lesiones por onda expansiva y algunos elementos que deben caracterizar al cirujano que presta atención a lesionados graves. Se concluyó que la atención al lesionado complejo precisa de una buena organización e incluye una atención prehospitalaria eficaz para comenzar la resucitación, y el cirujano asistente requiere de un alto nivel de competencia y desempeño