RESUMO
CASE: Animal injection-related needlestick injuries are a common occupational hazard for livestock workers and veterinarians. Although often unreported, these injuries can cause significant damage and may require extensive medical and surgical management. This case describes a 69-year-old farmer who accidentally injected his forearm while vaccinating cattle, resulting in a flexor compartment infection. Conservative management with oral and intravenous antibiotics was unsuccessful, and he required multiple surgical debridements for definitive treatment CONCLUSIONS:: Animal injection-related needlestick injuries can present unique challenges to orthopaedic surgeons. Important considerations include the injury location, needle type, vaccine volume and components, injection pressure, and environmental contaminants.
Assuntos
Abscesso/etiologia , Ferimentos Penetrantes Produzidos por Agulha/complicações , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Idoso , Animais , Antibacterianos/administração & dosagem , Bovinos , Desbridamento , Quimioterapia Combinada , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Ferimentos Penetrantes Produzidos por Agulha/tratamento farmacológico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Tratamento de Ferimentos com Pressão Negativa , ReoperaçãoRESUMO
Limited reconstructive options exist for soft tissue defects of the foot and ankle because of a lack of surrounding tissue. Although microsurgical free flaps have become a popular treatment modality for this anatomic region, pedicled muscle flaps can provide robust coverage of small foot wounds with significantly less donor site comorbidity. One such muscle is the abductor hallucis, which can be used as a proximally based turnover flap to cover medial hindfoot defects. However, complete distal disinsertion of the muscle may lead to loss of support over the medial arch and first metatarsophalangeal joint, leading to pes planus and hallux valgus. In this case report, we describe a modified technique of a split abductor hallucis turnover flap for a young patient with a chronic, traumatic medial heel wound complicated by calcaneal osteomyelitis. By preserving part of the muscle's distal tendinous attachment, this technique allows for adequate soft tissue coverage while maintaining long-term biomechanical function.
Assuntos
Úlcera do Pé/cirurgia , Retalhos de Tecido Biológico , Músculo Esquelético/transplante , Ferimentos Penetrantes Produzidos por Agulha/complicações , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Feminino , Úlcera do Pé/diagnóstico , Úlcera do Pé/etiologia , Humanos , Imageamento por Ressonância Magnética , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , RadiografiaAssuntos
Ferimentos Oculares Penetrantes/cirurgia , Injeções Intraoculares/efeitos adversos , Terapia a Laser , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Esclera/lesões , Cápsula de Tenon/efeitos dos fármacos , Triancinolona/administração & dosagem , Adulto , Ferimentos Oculares Penetrantes/etiologia , Glucocorticoides/administração & dosagem , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Papiledema/tratamento farmacológico , Descolamento Retiniano/tratamento farmacológico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgiaRESUMO
Fabricated and/or induced illness (previously known as Munchausen syndrome by proxy) is a form of child abuse in which the perpetrator induces, exaggerates or fabricates illness in his/her child. Two-month-old twins were referred to the paediatric surgery centre with trocar needles lodged in different organs. A radiograph undertaken in one of them because of acute respiratory distress demonstrated needles in the heart and diaphragm which were removed surgically. The second twin, referred one week after his brother, had a needle deep in his liver and it was decided not to operate owing to the possibility of haemorrhage but, sadly, he died unexpectedly and the autopsy concluded that it was owing to sudden infant death syndrome. Because of a number of admissions to different units in the same hospital, there was a delay in the eventual diagnosis. Recurrent admissions to different hospital units should raise the suspicion of fabricated and/or induced illness.
Assuntos
Síndrome de Munchausen Causada por Terceiro/diagnóstico , Síndrome de Munchausen Causada por Terceiro/patologia , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/patologia , Instrumentos Cirúrgicos , Gêmeos , Evolução Fatal , Humanos , Síndrome de Munchausen Causada por Terceiro/cirurgia , Ferimentos Penetrantes Produzidos por Agulha/cirurgiaAssuntos
Terapia por Acupuntura/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Traumatismos Cardíacos/diagnóstico , Ventrículos do Coração/lesões , Agulhas/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Terapia por Acupuntura/instrumentação , Feminino , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment.This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance.
Assuntos
Migração de Corpo Estranho , Injeções , Ferimentos Penetrantes Produzidos por Agulha , Músculos Paraespinais , Extração Dentária/efeitos adversos , Adulto , Instrumentos Odontológicos/efeitos adversos , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Injeções/efeitos adversos , Injeções/instrumentação , Masculino , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Agulhas , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/lesões , Músculos Paraespinais/cirurgia , Tomografia Computadorizada por Raios X/métodos , Extração Dentária/instrumentação , Extração Dentária/métodos , Resultado do TratamentoRESUMO
Iatrogenic traumatic endophthalmitis is a rare but serious ocular infection that can lead to severe vision loss. A 44-year-old man presented with pain and decreased vision in the right eye 4 hours after injury with a hypodermic needle during irrigation of his eye. Slit-lamp examination revealed a penetrating corneal puncture and iris hole in the right eye. Twenty hours later, his visual acuity had decreased to hand motion, and severe fibrinoid uveitis was noted. He immediately underwent irrigation of the anterior chamber and intravitreal antibiotic injection. The right eye became painful again, and emergent vitrectomy combined with lensectomy was performed along with intravitreal antibiotic administration. The patient remained stable during the 2-month follow-up. Standard practice should be adopted when irrigating the eye to prevent this type of injury, and emergent surgical intervention is very important to preserve visual function.
Assuntos
Antibacterianos/uso terapêutico , Endoftalmite/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Infecções por Pseudomonas/diagnóstico , Uveíte/diagnóstico , Vitrectomia , Adulto , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Endoftalmite/cirurgia , Olho/microbiologia , Olho/patologia , Humanos , Doença Iatrogênica , Injeções Intravítreas , Masculino , Agulhas , Ferimentos Penetrantes Produzidos por Agulha/tratamento farmacológico , Ferimentos Penetrantes Produzidos por Agulha/microbiologia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/cirurgia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/patogenicidade , Irrigação Terapêutica , Uveíte/tratamento farmacológico , Uveíte/microbiologia , Uveíte/cirurgiaAssuntos
Bacteriemia/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Traumatismos Cardíacos/complicações , Ventrículos do Coração/lesões , Ferimentos Penetrantes Produzidos por Agulha/complicações , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Adulto , Bacteriemia/diagnóstico , Bacteriemia/cirurgia , Remoção de Dispositivo , Ecocardiografia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/cirurgiaAssuntos
Aorta Torácica/lesões , Implante de Prótese Vascular/métodos , Hemotórax/etiologia , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Traumatismos Torácicos/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Lesões do Sistema Vascular/diagnóstico , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Feminino , Hemotórax/diagnóstico , Hemotórax/cirurgia , Humanos , Ferimentos Penetrantes Produzidos por Agulha/complicações , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/cirurgiaRESUMO
Retrobulbar injection of anesthesia is one of the most common procedures performed for ophthalmic surgery. Complications are rare but can be potentially serious, including retrobulbar hemorrhage, brainstem anesthesia, and inadvertent globe perforation. This is the preliminary report describing branch retinal vein occlusion (BRVO) secondary to accidental retrobulbar needle laceration with subsequent preretinal neovascularization.
Assuntos
Ferimentos Oculares Penetrantes/etiologia , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Retina/lesões , Neovascularização Retiniana/etiologia , Oclusão da Veia Retiniana/etiologia , Anestesia Local/instrumentação , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Neovascularização Retiniana/diagnóstico , Neovascularização Retiniana/cirurgia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/cirurgia , Acuidade Visual/fisiologiaRESUMO
Cardiac foreign bodies are rare in children and the nature or timing of the injury may be hard to ascertain. We report a case of a 10-year-old boy who presented with a 28-mm solid core needle in the left chest wall that advanced into his right ventricle, possibly from soft tissue manipulation. Computed tomography, intraoperative fluoroscopy, and echocardiography were necessary to locate the needle and successfully remove it surgically.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Ventrículos do Coração/lesões , Agulhas , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Criança , Ecocardiografia , Fluoroscopia , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Glucocorticoides/administração & dosagem , Injeções Intraoculares/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Facoemulsificação , Retina/lesões , Descolamento Retiniano/etiologia , Triancinolona Acetonida/administração & dosagem , Ferimentos Penetrantes/etiologia , Idoso , Humanos , Doença Iatrogênica , Implante de Lente Intraocular , Masculino , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Tomografia de Coerência Óptica , Uveíte Anterior/tratamento farmacológico , Uveíte Intermediária/tratamento farmacológico , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgiaRESUMO
INTRODUCTION: The ingestion of foreign bodies is a frequently observed problem in daily clinical practice. In order to avoid complications such as perforation, endoscopic removal of potentially penetrating foreign bodies should be attempted quickly. The use of various endoscopic techniques has been reported for this purpose. However, extraction of foreign bodies from the mid gastrointestinal tract has rarely been reported. CASE REPORT: We present the case of a patient who had swallowed a safety needle which could safely be removed from the jejunum by means of double-balloon enteroscopy (DBE). The combination of a thin p-type enteroscope with a thick t-type overtube was used in order to improve the manoeuvrability of the endoscope. The needle was pulled into the overtube which served as a protective shield during the retrieval of the endoscope. CONCLUSION: Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body.
Assuntos
Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Migração de Corpo Estranho/cirurgia , Jejuno/lesões , Jejuno/cirurgia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Idoso , Feminino , Migração de Corpo Estranho/patologia , Humanos , Jejuno/patologia , Ferimentos Penetrantes Produzidos por Agulha/patologia , Resultado do TratamentoRESUMO
Despite being rarely seen, penetrating cardiac injuries are clinically significant, as they are highly lethal. We herein present the case of a 3-year-old male who unintentionally injured himself by pricking his own chest with a sewing needle and introducing it through the left-lower margin of his sternum into his right ventricle. The needle was located anterior-posteriorly over the right ventricle. An anterior thoracotomy was performed, and the needle was safely removed. No hemorrhage or arrhythmia was seen, so the operation was ended. An early diagnosis and intervention proved to be life-saving for this penetrating cardiac injury.
Assuntos
Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/cirurgia , Agulhas/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Comportamento Autodestrutivo/complicações , Pré-Escolar , Diagnóstico por Imagem , Diagnóstico Precoce , Emergências , Corpos Estranhos/diagnóstico , Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Comportamento Autodestrutivo/prevenção & controle , Toracotomia/métodos , Resultado do TratamentoRESUMO
Self-inflicted eye injuries among psychiatric patients are rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the severely disturbed patient. They have been associated with a variety of disorders, including paranoid schizophrenia, drug-induced psychosis, obsessive-compulsive disorder, depression, mental retardation, and ritualistic behavior. It has been described in both adults and children, but occurs most commonly in young adults with acute or chronic psychoses.
Assuntos
Ferimentos Oculares Penetrantes/diagnóstico por imagem , Traumatismo Múltiplo , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico por imagem , Automutilação/complicações , Ferimentos Oculares Penetrantes/etiologia , Ferimentos Oculares Penetrantes/cirurgia , Seguimentos , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Radiografia , Adulto JovemRESUMO
Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.
Assuntos
Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Traumatismos dos Dedos/complicações , Infecções por Mycobacterium/diagnóstico , Mycobacterium bovis , Ferimentos Penetrantes Produzidos por Agulha/complicações , Doenças Profissionais/diagnóstico , Tenossinovite/diagnóstico , Doença Aguda , Administração Intravesical , Adulto , Antituberculosos/uso terapêutico , Terapia Combinada , Feminino , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/cirurgia , Humanos , Infecções por Mycobacterium/cirurgia , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Doenças Profissionais/cirurgia , Cuidados Pós-Operatórios , Tendões/cirurgia , Tenossinovite/cirurgiaRESUMO
In boys, most traumas to the scrotum result from sports or straddle injuries and do typically not inflict serious injury. Due to the small size and mobility of the prepubertal testicles, testicular injuries from penetrating trauma are less common in this age group. Penetrating scrotal injury, which poses a significant threat to testicular viability, is more prevalent among adolescents and young men. We describe two unusual genital injuries; one in childhood and the other in adulthood.
Assuntos
Prepúcio do Pênis/lesões , Escroto/lesões , Pré-Escolar , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico por imagem , Ferimentos Penetrantes Produzidos por Agulha/cirurgia , Radiografia , Escroto/diagnóstico por imagem , Escroto/cirurgia , Testículo/diagnóstico por imagem , Testículo/lesões , Testículo/cirurgia , Resultado do Tratamento , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/cirurgiaRESUMO
OBJECTIVE: The detailed outcome of surgical repair of high isolated clean sharp (HICS) ulnar nerve lesions has become relevant in view of the recent development of distal nerve transfer. Our goal was to determine the outcome of HICS ulnar nerve repair in order to create a basis for the optimal management of these lesions. METHODS: High ulnar nerve lesions are defined as localized in the area ranging from the proximal forearm to the axilla just distal to the branching of the medial cord of the brachial plexus. A meta-analysis of the literature concerning high ulnar nerve injuries was performed. Additionally, a retrospective study of the outcome of nerve repair of HICS ulnar nerve injuries at our institution was performed. The Rotterdam Intrinsic Hand Myometer and the Rosén-Lundborg protocol were used. RESULTS: The literature review identified 46 papers. Many articles presented outcomes of mixed lesion groups consisting of combined ulnar and median nerves, or the outcome of high and low level injuries was pooled. In addition, outcome was expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for further analysis. In our institution, 15 patients had nerve repair with a median interval between trauma and reconstruction of 17 days (range 0-516). The mean score of the motor and sensory domain of the Rosen's Scale instrument was 58% and 38% of the unaffected arm, respectively. Two-point discrimination never reached less then 12 mm. CONCLUSION: From the literature, it was not possible to draw a definitive conclusion on outcome of surgical repair of HICS ulnar nerve lesions. Detailed neurological function assessment of our own patients showed that some ulnar nerve function returned. Intrinsic muscle strength recovery was generally poor. Based on this study, one might cautiously argue that repair strategies of HICS ulnar nerve lesions need to be improved.