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Lilloni G, Ferri A, Lanfranco D, Ferrari S. The Evolution of Foreign Bodies Management in a Case of Near-fatal Penetrating Neck Injury. Indian J Otolaryngol Head Neck Surg 2024; 76:1375-1377. [PMID: 38440538 PMCID: PMC10909066 DOI: 10.1007/s12070-023-04291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024] Open
Abstract
Penetrating wounds of the neck with foreign bodies retention are frequent and often life-threatening events, and their management has changed in recent years from an open approach to a conservative approach thanks to the possibility of performing minimally invasive radiologically guided surgery. We present a case of penetrating glass injury to zone III of the neck in which the foreign body go through the parotid region passing near, but without injuring, the facial nerve and the external and internal carotid arteries.
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Affiliation(s)
| | - Andrea Ferri
- Maxillofacial Unit, University-Hospital of Parma, Parma, Italy
| | | | - Silvano Ferrari
- Maxillofacial Unit, University-Hospital of Parma, Parma, Italy
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2
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Ahmad SJ, Holland R, Castillo A, Brook AL, Altschul DJ, Kobets AJ. Nuances in detecting retained foreign bodies: a case report of a glass shard embedded in a child's scalp. Radiol Case Rep 2022; 17:1366-1369. [PMID: 35251420 PMCID: PMC8892023 DOI: 10.1016/j.radcr.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Foreign bodies (FBs) are a relatively common reason for admission to the emergency department, with subacutely embedded FBs presenting a diagnostic challenge to physicians. Retained FBs may cause the patient harm and result in litigation when missed. Diagnostic imaging is a powerful tool for localization of FBs and a physician's choice of modality should reflect its anticipated composition. This case report pertains to a 2-year-old boy with a glass shard embedded in his retro auricular scalp who presented with a painful subcutaneous lesion months after an overlying laceration repair at an outside emergency room. The attending neurosurgeon was able to identify a glass shard both on physical examination and axial T2-weighted MRI. Surgical exploration resulted in the removal of a 1-cm square glass shard. Key to the diagnostic potential of imaging is knowledge of a patient's relevant medical history and the composition of the suspected FB. Herein, we describe imaging modalities and their utility in the context of retained glass FBs.
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Affiliation(s)
- Samuel J. Ahmad
- Albert Einstein College of Medicine New York, 1300 Morris Park Ave, Bronx, New York, NY, 10461 USA
- Corresponding author.
| | - Ryan Holland
- Department of Neurosurgery, Montefiore Medical Center, New York, NY, USA
| | - Ashley Castillo
- Albert Einstein College of Medicine New York, 1300 Morris Park Ave, Bronx, New York, NY, 10461 USA
| | - Allan L. Brook
- Department of Radiology, Montefiore Medical Center New York, NY, USA
| | - David J. Altschul
- Department of Neurosurgery, Montefiore Medical Center, New York, NY, USA
| | - Andrew J. Kobets
- Department of Neurosurgery, Montefiore Medical Center, New York, NY, USA
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3
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Carneiro BC, Cruz IAN, Chemin RN, Rizzetto TA, Guimarães JB, Silva FD, Junior CY, Pastore D, Ormond Filho AG, Nico MAC. Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges. Radiographics 2021; 40:1965-1986. [PMID: 33136481 DOI: 10.1148/rg.2020200061] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic wounds and lacerations are a common reason for patients to present to emergency departments, with retained foreign bodies (FBs) accounting for 7%-15% of cases, particularly those involving the extremities. These retained materials result in a granulomatous tissue response known as an FB reaction, a pathologic attempt to isolate the FB from the host. The most common FB materials are glass, metal, and wood, but other compositions can also be found, such as plastic and animal-derived materials. Clinical history, physical examination, and wound exploration are essential in investigation of retained material but are not sufficient to exclude an FB, and additional investigation is required. Imaging evaluation is a useful tool to help depict and locate an FB, assess possible complications, and guide removal. Conventional radiography, the first-line method in this scenario, is a widely available low-cost depiction method that has good sensitivity for depicting FBs. If the retained material is not depicted at conventional radiography, US can be performed. US is highly sensitive in depicting both radiolucent and radiopaque FBs in superficial locations. For deeper objects, CT may be necessary. MRI is the best imaging modality to delineate local soft-tissue and osseous complications. Retained FBs can result in early and delayed complications, with infection being the most frequent complication. To avoid preventable morbidities related to FBs, radiologists should be familiar with imaging findings and provide essential information to help the attending physician treat each patient. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Bruno C Carneiro
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Isabela A N Cruz
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Renan N Chemin
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Thiago A Rizzetto
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Júlio B Guimarães
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Flávio D Silva
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Ciro Yoshida Junior
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Daniel Pastore
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Alípio G Ormond Filho
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Marcelo A C Nico
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
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Albayati WK, Farhan N, Jasim AK, Qassim YN, Ali AA. The utility of a novel vacuum-assisted foreign body extraction technique from wounds. JPRAS Open 2020; 27:27-33. [PMID: 33313371 PMCID: PMC7720073 DOI: 10.1016/j.jpra.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/10/2020] [Indexed: 01/02/2023] Open
Abstract
Retained soft tissue foreign bodies following injuries are frequently seen in the Emergency and Plastic Surgery practice. The patients with such presentations require a watchful and detailed clinical assessment to overcome the anticipant possibility of missing them. However, the diagnosis based on the clinical evaluation is usually challenging and needs to be supported by imaging modalities that are suboptimal and may fail in identifying some types of foreign bodies. Owing to that, serious complications such as chronic pain, infection, and delayed wound healing can be faced that necessitate a prompt intervention to halt those detrimental consequences. The classical method of removal is a surgical exploration which is not free of risks. It can cause injuries to vital structures such as nerves and tendons if the foreign body is close to them, also it can be affected by the surgeon's experience and the foreign body's characteristics. In light of that, we conducted a single-center study to understand the utility of a novel vacuum-assisted technique for foreign body removal. The technique is noninvasive and facilitates a real-time foreign body extraction using readily available materials. Twenty patients with 23 Foreign Bodies of various kinds, shapes, and sizes were recruited in our study by using a nonprobability convenient sampling method. Results demonstrated the ability of the described technique to extract 22 of them with no noticeable side effects. This study may encourage further trials adopting similar principles to promote the management of retained foreign bodies with fewer complications, and a potential of time and cost-saving.
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Affiliation(s)
- Waleed Khalid Albayati
- Ghazi al-Hariri Surgical Specialties Hospital, Department of Plastic and Reconstructive Surgery, Medical City, Baghdad, Iraq
| | - Nawras Farhan
- Ghazi al-Hariri Surgical Specialties Hospital, Department of Plastic and Reconstructive Surgery, Medical City, Baghdad, Iraq
| | - Ahmed Khalaf Jasim
- Department of Surgery, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Yasir Naif Qassim
- Department of Surgery, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Ali Adwal Ali
- Department of Surgery, College of Medicine, Kirkuk University, Kirkuk, Iraq
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Bord S, El Khuri C. High-Risk Chief Complaints III. Emerg Med Clin North Am 2020; 38:499-522. [DOI: 10.1016/j.emc.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Uludağ A, Tosun HB, Çiçek N, Şirik M, Uludağ Ö, Atiç R. Yaralanma Sonrası Ekstremitelerin Yumuşak Dokusunda Gözlenen Yabancı Cisimlere Cerrahi Yaklaşım. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.539936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Improved Detection of Foreign Bodies on Radiographs Using X-ray Dark-Field and Phase-Contrast Imaging. Invest Radiol 2018; 53:352-356. [DOI: 10.1097/rli.0000000000000450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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8
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Navanandan N, Renna-Rodriguez M, DiStefano MC. Pearls in Pediatric Wound Management. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Blackhall KK, Laraway DC. Penetrating retro-orbital foreign body - large glass shards: A maxillofacial surgery case report. SAGE Open Med Case Rep 2016; 4:2050313X15622890. [PMID: 27489707 PMCID: PMC4927210 DOI: 10.1177/2050313x15622890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/20/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives: This case report looks at a 53-year-old patient who had suffered a penetrating foreign body injury to the retro-orbital space and the surgical approach taken to remove the large glass fragments found and to correct the damage caused. Having fallen while holding a drinking glass, this patient suffered multiple laceration injuries to the maxillofacial region upon the glass shattering in contact with the face. However, unbeknownst to the patient, several glass fragments became embedded in the retro-orbital space, and this was only detected on presentation 2 days post-injury with unusual symptoms of sharp, sudden pain elicited on extreme gaze as well as ocular motility restriction. Methods: This embedded foreign body required a creative surgical approach to remove it involving gaining access to the retro-orbital space via a superior approach and cautiously following the path the glass shards took upon entry, all the way to the posterior aspect of superior rectus. Intra-operative radiographic guidance was required due to the restriction of operating within this space and particularly when removing glass fragments distal to superior rectus. Results and Conclusion: The patient recovered well and experienced an immediate improvement in ocular motility with a return to relative normality over the next few months.
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Affiliation(s)
| | - David C Laraway
- Maxillofacial Surgery Unit, Aintree University Hospital, Liverpool, UK
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10
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Abstract
Infections of the foot are very variable, some being complex in nature, causing pain, morbidity, and even mortality. In patients with diabetes mellitus, foot infections are common, ranging from chronic bacterial or fungal infections to serious limb-threatening ones. To manage infections, a sound knowledge of anatomy is essential. This article reviews the problems with respect to recent evidence and provides pathways to management and suggestions of changes with potential to wound healing.
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Affiliation(s)
- M A Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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11
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Hidden Infratemporal Foreign Body Late Presenting as Cheek Mass. J Craniofac Surg 2016; 27:1611-2. [PMID: 27300461 DOI: 10.1097/scs.0000000000002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Madhan B, Arunprasad G, Krishnan B. Glass fragment embedded in the cheek: a missed radiographic finding. BMJ Case Rep 2015; 2015:bcr-2015-210542. [PMID: 26670889 DOI: 10.1136/bcr-2015-210542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Balasubramanian Madhan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gnanasekaran Arunprasad
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Davis J, Czerniski B, Au A, Adhikari S, Farrell I, Fields JM. Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis. Acad Emerg Med 2015; 22:777-87. [PMID: 26111545 DOI: 10.1111/acem.12714] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Open wounds with the potential for retained foreign bodies are frequently seen in the emergency department (ED). Common foreign bodies, such as wood or glass, are often missed on physical examination and conventional radiography. The increased use of ultrasonography (US) in the ED presents an opportunity to better identify retained soft tissue foreign bodies, and understanding of its test characteristics is desirable. The authors set out to determine the test characteristics of US for detection of soft tissue foreign bodies by performing a systematic review and meta-analysis of the existing literature. METHODS This was a thorough, systematic review of OVID Medline, SCOPUS, and Cochrane databases and a limited review of Directory of Open Access Journals, Google Scholar, and ClinicalTrials.gov to identify clinical studies examining the diagnostic accuracy of US in the identification of retained soft tissue foreign bodies. Studies were selected for full-text review by two independent reviewers to determine if they met inclusion criteria. Results were pooled for test characteristics using STATA and assessed for risk of bias and applicability using the QUADAS-2 tool. RESULTS This systematic search strategy identified 5,059 unique articles, and 17 articles met inclusion criteria. Pooled sensitivity and specificity were, respectively, 72% (95% confidence interval [CI] = 57% to 83%) and 92% (95% CI = 88% to 95%). Overall quality of the studies was low and interstudy heterogeneity was high (I(2) = 90%, 95% CI = 80% to 100%). CONCLUSIONS Ultrasonography is highly specific and moderately sensitive in the identification of retained soft tissue foreign bodies; however, studies to date have a high degree of heterogeneity and a high risk of bias.
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Affiliation(s)
- Joshua Davis
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA
| | - Byron Czerniski
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA
| | - Arthur Au
- Department of Emergency Medicine; Thomas Jefferson University; Philadelphia PA
| | - Srikar Adhikari
- Department of Emergency Medicine; University of Arizona; Tucson AZ
| | - Isaac Farrell
- Department of Emergency Medicine; University of Arizona; Tucson AZ
| | - J. Matthew Fields
- Department of Emergency Medicine; Thomas Jefferson University; Philadelphia PA
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14
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Multimodality Imaging of Foreign Bodies of the Musculoskeletal System. AJR Am J Roentgenol 2014; 203:W92-102. [DOI: 10.2214/ajr.13.11743] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Ranganatha B, Pawan Kumar K. Canine tooth in hand - A rare entity. J Clin Orthop Trauma 2014; 5:91-3. [PMID: 25983477 PMCID: PMC4085363 DOI: 10.1016/j.jcot.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/19/2014] [Indexed: 11/27/2022] Open
Abstract
The hand plays an important role in day to day activities and is more prone for accidental injuries. Injuries to the hand are frequently associated with foreign body penetration. Many a times the foreign body is not detected at the initial visit and can later present with other complications. We present a case of canine tooth presenting as a retained foreign body in the hand following a dog bite. The article stresses the importance of looking for foreign bodies in penetrating hand injuries, even in wounds that seem to be minor in nature.
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Affiliation(s)
- B.T. Ranganatha
- Specialist/Assistant Professor, Department of Orthopaedics, ESIC MC PGIMSR and Model Hospital, Rajajinagar, Bangalore 560010, India,Corresponding author. Tel.: +91 9632055551 (mobile).
| | - K.M. Pawan Kumar
- Senior Resident, Department of Orthopaedics, ESIC MC PGIMSR and Model Hospital, Rajajinagar, Bangalore 560010, India
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Kempf L, Braun KF, Neu J. [Foreign body retention after soft tissue laceration. A case of insufficient inspection and documentation]. Unfallchirurg 2014; 117:162-6. [PMID: 24474417 DOI: 10.1007/s00113-013-2535-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 52-year-old man sustained a laceration to his left eyebrow after a fall in his bathroom. His plastic glasses shattered upon impact. The patient was referred to a local emergency department. After a quick exploration by the physician on call, the wound was closed by a nurse using the Steri-Strip Wound Closure system. No further exploration or imaging was performed. Four weeks after the incident the patient presented to a dermatologist with a "foreign body sensation" at the site of the laceration. Assuming a foreign body granuloma, he was referred to a maxillofacial surgeon who removed plastic debris (parts of the glasses worn by the patient). The wound subsequently healed without further complications.The patient filed a complaint for inadequate treatment in the emergency department. No detailed patient and accident history had been obtained, the wound exploration performed by the physician was superficial, and the wound closure was performed by a nurse. The expert opinion of the arbitration board ascertained a medical malpractice in terms of insufficient history, examination, and a lack of documentation. Specific questioning of the accident history would have led to the suspicion of possible foreign bodies, thus, leading to a more thorough exploration and likely further imaging. The arbitration board concluded that obtaining a detailed accident history and an accurate examination would have revealed the foreign bodies and/or led to further imaging. Complying with this, the patient could have been spared further harm and secondary surgery would have been unnecessary.
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Affiliation(s)
- L Kempf
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität, Ismaninger Straße 22, 81675, München, Deutschland,
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Abstract
A retrospective study was carried out wherein 10 patients with glass particle injury reporting to the Department of Oral and Maxillofacial Surgery between January 2011 and March 2012 were included. Preoperative photographs and radiographs were done, and detailed surgical planning followed. Ninety percent of the patients were males with involvement of the right side of the face in 70% of the cases. The most common presenting symptom was patient sensation, which was the reason for availing delayed treatment in 70% of cases, followed by delayed or fibrotic healing (20%) and pain (10%). The diagnosis and planning were done based on computed tomographic scan (50% cases), plain radiographs (30%), needle as tactile aid (10%), and palpation (10%). Eighty percent of cases were diagnosed/presented late. The timely diagnosis of glass particle injuries requires a high degree of suspicion for the same. A systematic diagnosis and treatment planning for such injuries can minimize the morbidity and prevent such injuries from being overlooked at time of primary injury.
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Abstract
Puncture wounds of the foot are a common injury, and infection associated with these injuries may result in considerable morbidity. The pathophysiology and management of a puncture wound is dependent on the material that punctures the foot, the location and depth of the wound, time to presentation, footwear, and underlying health status of the patient. Puncture wounds should not be treated lightly, so accurate diagnosis, assessment, and treatment are paramount. Early incision and drainage, vaccination, and the use of proper antibiotics can lead to positive outcomes and prevent limb-threatening circumstances.
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Affiliation(s)
- Ronald Belin
- Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, USA.
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Evaluation of patients undergoing removal of glass fragments from injured hands: a retrospective study. Ann Plast Surg 2012; 67:114-8. [PMID: 21372675 DOI: 10.1097/sap.0b013e3181f211e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The hand is the body part most frequently injured by broken glass. Glass fragments lodged in soft tissues may result in numerous complications, such as infection, delayed healing, persistent pain, and late injury as a result of migration. Between 2005 and 2010, we removed 46 glass particles from the hands of 26 patients. The injuries were caused by the following: car windows broken during motor vehicle accidents in 11 patients (42%); fragments from broken glasses, dishes, or bottles in 9 (35%); the hand passing through glass in 5 (19%); and a fragment from a broken fluorescent lamp in 1 (4%) patient. Despite the efficacy of plain radiographs in detecting glass fragments, these are sometimes not obtained. Given the relatively low cost, accessibility, and efficacy of radiographs, and the adverse consequences of retained foreign bodies, the objections to obtaining radiographs should be few in diagnosing glass-related injuries of the hand.
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20
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Salati SA, Rather A. Missed foreign bodies in the hand: an experience from a center in Kashmir. Libyan J Med 2010; 5. [PMID: 21483579 PMCID: PMC3071174 DOI: 10.3402/ljm.v5i0.5083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/22/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction Penetrating hand injuries are common and improper assessment can result in missed foreign bodies. These bodies can result in a wide range of complications. Aim The aim of our study was to study the profile of patients reporting with missed foreign bodies in the hand. Materials and methods All the cases treated in the Department of Surgery, Sheri Kashmir Institute of Medical Sciences (medical college), Kashmir, for missed foreign bodies in hands from June 2003 to May 2009 were studied retrospectively. Results A total of 61 cases with missed foreign bodies of different nature were treated over the period of six years. Wooden splinters were the most common foreign bodies missed. Preoperative localization was accomplished with plain radiographs and ultrasonograms. Most of the cases were treated on outpatient basis. Conclusions Foreign bodies should be suspected and ruled out in all cases of penetrating injuries of hands. Missed foreign bodies need to be removed after proper localization by imaging.
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Abstract
Abdominal and extremity complaints are a frequent reason for presentation to the emergency department. Although these are common complaints, several abdominal and extremity disease entities may be missed or may be subject to delayed diagnosis. This article provides an overview of the diagnosis and management of several high-risk abdominal and extremity complaints, including appendicitis, abdominal aortic aneurysm, mesenteric ischemia, bowel obstruction, retained foreign body, hand and finger lacerations, fractures, and compartment syndrome. Each section focuses primarily on the pitfalls in diagnosis by highlighting the limitations of history, physical examination findings, and diagnostic testing and provides specific risk management strategies.
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Affiliation(s)
- Karis Tekwani
- Department of Emergency Medicine, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA
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22
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Clinical characteristics and management of wound foreign bodies in the ED. Am J Emerg Med 2008; 26:918-22. [DOI: 10.1016/j.ajem.2007.11.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/15/2007] [Accepted: 11/17/2007] [Indexed: 11/20/2022] Open
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Weinberger LN, Chen EH, Mills AM. Is Screening Radiography Necessary to Detect Retained Foreign Bodies in Adequately Explored Superficial Glass-Caused Wounds? Ann Emerg Med 2008; 51:666-7. [PMID: 17588705 DOI: 10.1016/j.annemergmed.2007.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren N Weinberger
- University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA 19104-4283, USA
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Abstract
Although substantial dollar amounts are not involved, wound-care litigation constitutes a significant number of lawsuits to emergency medicine physicians, resulting in an increased drain on the physician's time and exposing the physician to all the psychosocial effects involved in the medicolegal process. The procedures outlined in this article-paying attention to wound-care principles, involving patients in the medical decision-making process, and ensuring appropriate medical follow-up-can, it is hoped, reduce the incidence of medical claims.
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Affiliation(s)
- James A Pfaff
- San Antonio Uniformed Health Services Health Education Consortium Emergency Medicine Residency, San Antonio, TX, USA.
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25
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Orlinsky M, Bright AA. The utility of routine x-rays in all glass-caused wounds. Am J Emerg Med 2006; 24:233-6. [PMID: 16490657 DOI: 10.1016/j.ajem.2005.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2005] [Indexed: 10/25/2022] Open
Abstract
It is a common practice to routinely obtain x-rays before clinical evaluation and cleaning of glass-caused wounds to assess for possible retained foreign bodies (FBs). [Am J Surg 1982;144(July):63-5; Ann Emerg Med 1983;12(July):434-7; Emerg Med Clin NorthAm 1985;3(2):383-91; Emerg Med Clin North Am 1992;10:163-77; Ann Emerg Med 1988 17(12):125-34; Emerg Med Clin North Am 1992;10(4):757-79] This prospective study was designed to question whether routine x-rays are necessary for all patients with glass-caused wounds. Plain films were taken before clinical exam but not reviewed until after the exam was completed. Wounds were categorized according to depth, whether or not the clinician was able to adequately explore the wound, and whether or not an FB was found clinically. Glass FBs were found in 23 (8.7%) of 264 wounds. Approximately half of the wounds were no deeper than subcutaneous fat. Almost all of these superficial wounds (99.2%, 133/134) could be adequately explored. There were clinically undetected FBs (ie, wounds that benefited from x-ray) in 2 (1.5%) of 134 superficial wounds and 10 (7.7%) of 130 deeper wounds. In light of the benign nature of the 2 superficial wounds in which an FB was missed clinically, we conclude that there exists a subset of glass-caused wounds that are superficial and adequately explorable, and, therefore, do not need routine x-rays.
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Affiliation(s)
- Michael Orlinsky
- Department of Emergency Medicine, LAC+USC Medical Center, University of Southern California Keck School of Medicine, Los Angeles, 90033, USA
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Narita N, Yamada T, Imoto Y, Ogi K, Sakashita M, Ito Y, Kouraba S, Yasuta M, Tsuzuki H, Fujieda S. Treatment of scattered glass foreign bodies in both the superficial and deep neck: A case report. Auris Nasus Larynx 2005; 32:295-9. [PMID: 15869854 DOI: 10.1016/j.anl.2005.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Revised: 01/28/2005] [Accepted: 03/25/2005] [Indexed: 11/15/2022]
Abstract
There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.
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Affiliation(s)
- Norihiko Narita
- Department of Otorhinolaryngology, Faculty of Medicine, University of Fukui, Matsuoka, Fukui 910-1193, Japan
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Abstract
Upon necroscopic examination of a homeless male found comatose in the street and pronounced dead at a medical center 12 hours later, a sharp tip of a knife lodged in the right parietal region of his skull was incidentally discovered. The blade transected the diploe and penetrated the cerebral cortex. Subsequent police investigation revealed that this was the remnant of a stabbing attempt on his life several months prior to his death. The cause of death was determined to be unrelated to the metallic blade fragment, thus making it a truly incidental and rare finding of a "souvenir knife." Nevertheless, since the injury sustained in the stabbing was potentially life threatening, the investigation into that assault was reopened.A case report is presented, along with a brief review of the literature on "souvenir objects."
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Affiliation(s)
- Neil L Davis
- National Center of Forensic Medicine, Tel Aviv, Israel
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Venter NG, Jamel N, Marques RG, Djahjah F, Mendonça LDS. Avaliação de métodos radiológicos na detecção de corpo estranho de madeira em modelo animal. Acta Cir Bras 2005. [DOI: 10.1590/s0102-86502005000700005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliar diferentes métodos radiológicos no diagnóstico de corpos estranhos (CEs) de madeira. MÉTODOS: Foram utilizados 11 frangos adultos. Realizou-se lesão perfurante, em cada sobrecoxa do animal. Em um dos lados, foi introduzida e deixada uma farpa de madeira e, na sobrecoxa contralateral, esse mesmo objeto foi introduzido e retirado (Grupo Controle). Após sete dias, os animais foram mortos e tiveram seus membros retirados para avaliação por radiografia simples (RS), ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnética (RM). Cada exame foi avaliado, independentemente, por dois radiologistas experientes. RESULTADOS: A sensibilidade foi 13,6% para RS, 63,3% para US, 59,1% para RM e 72,7% para TC, com especificidades de 100%, 100%, 95,5% e 95,5%, respectivamente. O valor preditivo positivo foi de 100% para RS e US, de 95% para TC e de 93,8% para RM, enquanto o valor preditivo negativo foi de 53,7%, 73,7%, 78,3% e 70,1%, respectivamente. A acurácia foi de 84,1%, para TC, de 81,8% para US, de 77,3% para RM e de 56,8% para RS. Comprovou-se, histologicamente, presença de reação inflamatória em todas as sobrecoxas que continham CE. CONCLUSÃO: RS apresenta pequena utilidade na detecção radiológica de CE de madeira em frango, devendo-se optar pelo emprego de US e TC, seguido por RM.
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Opel DJ, Lundin DA, Stevenson KL, Klein EJ. Glass foreign body in the spinal canal of a child: case report and review of the literature. Pediatr Emerg Care 2004; 20:468-72. [PMID: 15232251 DOI: 10.1097/01.pec.0000136894.91647.6f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Retained foreign bodies pose a risk to the patient from the perspective of potential morbidity. We describe a previously healthy 8-year-old boy with head and back trauma from a glass picture frame that fell off the wall. He sustained a closed head injury and a back laceration several centimeters lateral to the spine. A persistent drainage from the back laceration contained glucose and protein levels consistent with cerebral spinal fluid. A foreign body was easily visible on subsequent plain radiograph. The glass foreign body was removed by neurosurgeons after computed tomography and magnetic resonance imaging clarified the exact location of the glass fragment. Physicians should have a low threshold for obtaining plain radiographs in patients with glass foreign bodies and consider that projectiles may rest some distance from the laceration site.
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Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Abstract
The goals of wound management are simple: avoid infection and achieve a functional and aesthetically pleasing scar. This is achieved by reducing tissue contamination, debriding devitalized tissue, and restoring perfusion in poorly perfused wounds, in conjunction with a well-approximated skin closure.
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Affiliation(s)
- Otilia Capellan
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19145, USA
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