Cases reported "Blast Injuries"

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1/39. Treatment of casualties of military conflicts at the Critical medicine Clinic of the Central Hospital in georgia.

    INTRODUCTION: Local military conflicts continue in many areas of the world. These conflicts produce multiple casualties to military personnel and civilians. This paper describes one aspect of the medical care required for victims of the civil conflict in the Republic of georgia. methods: Interviews with patients and their accompanying persons and abstraction of medical records. RESULTS: Data were acquired on 108 victims admitted to the Center for Critical medicine in Tbilisi. Three stages in the care of these victims are described: 1) battlefield and transportation; 2) regional, front-line hospitals; and 3) the Central Hospital. The performance of each stage is described. Distribution of injuries and procedures performed in the third stage of treatment are described and survivors are defined. For illustration, two cases are reviewed in detail. CONCLUSIONS: The results are encouraging. Major problems existed in the treatment and evacuation of the wounded. Furthermore, many of the victims were injured because of their carelessness and lack of experience on the battlefield.
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ranking = 1
keywords = wound
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2/39. arthroplasty after war injuries to major joints.

    From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.
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ranking = 3
keywords = wound
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3/39. Transoral missile removal from the anterior C1 region following transpharyngeal missile wound.

    We present a successful treatment result in a rare case of low velocity missile transpharyngeal wound to the upper cervical area in a 33-year-old man. There are very few reports concerning related cases, with some disagreement regarding their treatment. The retained missile was successfully removed from the anterior region of the C1 vertebra through a transoral-transpharyngeal approach using the explosive transpharyngeal wound sustained. Neurological status and spine stability were not affected due to the missile's low velocity. The early soft-tissue debridement, missile removal, pharyngeal closure without wound drainage and broad-spectrum antibiotic coverage resulted in an uneventful postoperative course and good long-term outcome. Early surgery is important to prevent complications in such cases. However, the prophylactic tracheostomy, wound drainage and applying of a nasogastric tube could be left to the surgeon's judgment based on the individual patient's respiratory status, intraoperative findings and wound contamination/colonization.
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ranking = 9
keywords = wound
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4/39. Injuries from hand grenades in civilian settings.

    Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density. This leads to rapid deceleration and thus to a poor penetration capacity of intermediate targets and tissue. Window glass at a distance of 2 m was not perforated in one case and the vast majority of fragment wounds showed a short wound tract of small diameter. The potential for physical activity can be unaffected even after a detonation inside a car. However, body parts almost in contact with the hand grenade, such as in a struggle, suffer large lacerations and comminuted fractures. At a distance, the chance of striking a vulnerable body region is increased by the multiple missiles but the wounding potential clearly decreases with increasing distance due to rapid deceleration and decreasing fragment cloud density. The effective range of detonation shock waves from hand grenades is very short and can only contribute to wounding in close-to-contact detonations. The forensic reconstruction is based on the directed radial character of the forces generated and on the sharply decreasing intensity of these forces with increasing distance from the detonation.
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ranking = 4
keywords = wound
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5/39. Field hospital treatment of blast wounds of the musculoskeletal system during the Yugoslav civil war.

    The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former yugoslavia was reviewed. patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.
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ranking = 11
keywords = wound
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6/39. Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.

    When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. The vascular pathology of the injured extremities indicated a cross-leg procedure instead of a free flap transfer. Pedicles were wrapped with split-thickness skin grafts and flaps were harvested superficial to the plantar fascia. Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.
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ranking = 7
keywords = wound
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7/39. Dehiscence of radial keratotomy wounds without globe rupture following explosion injury.

    PURPOSE: To report a case of explosive trauma to a patient with a history of radial keratotomy (RK), which resulted in multiple wound dehiscences but not globe rupture. methods: A 29-year-old male underwent radial keratotomy 1 year before he sustained facial trauma from a gasoline tank explosion. Corneal abrasions were treated with copious irrigation, topical antibiotics, corticosteroids, and scopolamine. He did not have a ruptured globe in either eye. RESULTS: The incision sites from radial keratotomy had evidence of anterior dehiscence in both eyes. One month following the injury, the patient had corrected visual acuity of 20/20-1 in the right eye and 20/25 1 in the left eye. At that time, the RK wounds were well healed with minimal irregularity over the incision sites. CONCLUSION: This case demonstrates the excellent recovery of visual acuity in a patient with a partial thickness traumatic wound rupture 12 months following radial keratotomy.
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ranking = 7
keywords = wound
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8/39. Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury.

    Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.
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ranking = 1
keywords = wound
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9/39. Frontobasilar blast injuries: access and treatment.

    blast injuries involving the frontobasilar region and orbit can present difficult evaluation and treatment challenges. This article presents the surgical treatment of four patients presenting with blast-type injuries involving the central periorbital region and anterior skull base. Three of these were the result of close-range gunshot wounds, and one was caused by an avulsive penetrating tree branch injury during a motor vehicle accident. All four patients underwent frontal craniotomy for exposure to repair significant intracranial injuries. Following intracranial repair of dural and brain injuries, anterior cranial fossa reconstruction was performed. In two of these patients, elective supraorbital osteotomies were performed to allow improved access to the posterior aspect of the anterior skull base. The healing period of all four patients has been without complications relative to the anterior fossa injuries.
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ranking = 1
keywords = wound
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10/39. Penetration of a piece of world war ii rifle grenade initially suspected as a stab wound.

    The authors report the case of a 58-year-old man found dead by his son in the forest where he had gone to cut wood for winter. Initial examination showed an upper left laterocervical wound compatible with a stab wound. radiography and autopsy performed the next day showed a piece of metal located in the left part of the occipital bone, associated with a half-ring fracture of the occipital bone and consequent diffuse subarachnoid hemorrhage. death was attributed to a spinal shock after impact at the cervicocephalic junction. Investigators returned to the scene and found a few more metal elements and also a 20-cm deep and 40-cm wide crater underneath a fire the deceased had set. Army experts concluded that the metal pieces belonged to an ATM 9 antitank rifle grenade used by the U.S. Army during world war ii. death was considered accidental, the deceased having unfortunately set a fire over the grenade.
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ranking = 6
keywords = wound
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