Penetrating injuries to the head and neck

A review of the incidence of penetrating injuries to the head and neck in Jamaica reveals an increase of almost 100 percent from 1974 to 1987 from a average of 57 cases per year in 1974 to 135 cases per year in 1997. In the USA from 1967 to 1983 (16 years) the increase was 48 percent with a projected 2 percent annual increase for industrialised cities: for example: 1. In 1975 there were 112 stab wounds and 98 gun shot wounds to the head and neck. 2. In 1976 there were 118 stab wounds and 121 gun shot wounds to the head and and neck. Penetrating injuries from firearms have risen steadily in Jamaica to equal those from stab wounds and this due to increase in the use of illegal weapons; for example: 1. In 1974 there were 17 stab wounds and 6 gun shot wounds to the head and neck. 2. In 1997 there were 27 stab wounds and 24 gun shot wounds to the head and neck. The typical victim of this injury is a male in his late teens to twenties and the left side of his head and neck is the most common site of injury. The type of object or weapon which inflicts the injury also affects the severity of the injury. Stab wounds cause fewer severe injuries than a machete chop, but with the introduction of firearms with muzzle velocities in the region of 760 metres per second, injury to both sides of the head and neck is possible with one missile. Management in Jamaica is based on selective exploration of these injuries. Our mortality rate of patients who reach the operating table alive does not exceed 1 percent.(AU)

Exotic injuries of the central nervous system

Head injuries are the most common reason for admission among the injured at the University Hospital of the West Indies. Intentional injuries account for 52 percent of all trauma admissions. We report a unique group of 6 patients with central nervous system injuries, all intentional with the offending weapon in situ on arrival at hospital. 4 patients had weapons embedded in the head: two were knives, and one each was an ice-pick and a harpoon from a fishing device. The two other patients sustained spinal, cord injuries from ice-pick wounds. Principles of management involved radiological assessment of the injury to elucidate the position of the weapon, removal of the weapon under controlled circumstances in the operating theatre suite, prevention of infection and seizure prophylaxis. Operations performed were craniotomy, craniectomy and exploration of the spinal injuries. Two deaths occurred. In one, a spinal abscess developed six months after injury with the patient succumbing to sepsis. The other was an unexplained death following craniotomy and removal of a knive which severed the internal carotid artery. The cost of managing these intentional injuries was far greater than for the average patient and significantly demonstrates the burden on the taxpayer to treat these injuries(AU)

Non-operative management of stab wounds to the abdomen with omental evisceration

A consecutive series of 12 patients with anterior abdominal stab wounds and omental evisceration treated at the Kingston Public Hospital Jamaica over a 3-year period is presented. During this period 223 patients with abdominal stab wounds were seen of which 66 had omental evisceration. Conservative surgical management was the approach followed in 14 patients who presented without signs of peritonitis. There were no late complications or missed visceral injuries necessitating laparotomy. Serial physical examination was the method used to select patients for conservative surgical management with the exclusion of patients with deteriorating clinical signs or peritonitis. Omental evisceration through an abdominal stab wound in a patient with stable clinical signs and without evidence of peritonitis is not an absolute indication for exploratory laparotomy. (AU)

Management of penetrating abdominal injuries

One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67 percent) patients had stab wounds and thirty-seven (33 percent) sustained gunshot wounds. There were 10 deaths (27 percent) from gunshot wounds, and seven deaths (9 percent due to stab wounds. Using a protocol of selective conservatism for stab wounds, 41 (60 percent) were observed, 27 (40 percent) explored and 5 (12 percent) patients had negative laparotomy. The male to female ratio was 10: with 88 percent in the age group 16-35 years. A decision to perform laparotomy was used and is recommended (AU)