Pulmonary fat embolism (PFE) and pulmonary thromboembolism (PTE) are common post-operative complications of orthopedic surgical procedures, but are reported less often following maxillofacial plastic surgical procedures, especially with respect to PFE. Thrombi, or together with fat emboli in pulmonary vessels can induce hemorrhagic infarction and cause death. Herein this report introduced a death due to pulmonary hemorrhagic infarction following maxillofacial plastic surgery. The female patient underwent several osteotomies of the mandible, zygomas and autologous bone grafting within a single operation. The operative time was longer than normal and no preventive strategies for pulmonary embolism were implemented. The patient died 20 days after hospital discharge. The autopsy confirmed pulmonary hemorrhagic infarction. The fat emboli and thrombi were also noted in the pulmonary vessels, which were thought to have resulted from the maxillofacial osteotomy. Suggestions were offered to forensic pathologists that risk factors of PFE and PTE, such as the type and length of surgery, the surgical sites, and the preventive strategies, should be considered when handling deaths after maxillofacial operations.
Adult ; Autopsy ; Cause of Death ; Embolism, Fat/complications* ; Fatal Outcome ; Female ; Forensic Pathology ; Humans ; Infarction/etiology* ; Maxillary Osteotomy ; Postoperative Complications ; Pulmonary Embolism/complications* ; Surgery, Plastic/adverse effects* ; Thromboembolism/complications*

OBJECTIVE: To analyze the general and forensic pathological characteristics of death due to fat embolism syndrome (FES) and to provide reference data for forensic identification. METHODS: Twenty autopsy cases due to FES were selected from the forensic center of a medical college from 1999 to 2012. The general and forensic pathological characteristics such as the ways and types of injuries, clinical manifestation and the pathological changes were summarized. RESULTS: Fat embolism mainly occurred after long bone fracture or a large area of soft tissue injury with the majority of cases being fat embolism of lung and occasional cases being combined embolisms of lung and brain as well. The onset of symptoms appeared shortly after the injury or surgery. Lipid droplets could be observed within small pulmonary vessels and verified by special staining. CONCLUSION There are particular characteristics in death due to FES in concern with types of injuries, onset of symptoms and pathological findings. In order to find out the direct evidence of FES, special staining (oil red O staining) can be used in the forensic identification.
Autopsy ; Cause of Death ; Death ; Embolism, Fat/mortality* ; Forensic Pathology ; Fractures, Bone/complications* ; Humans ; Male ; Middle Aged ; Pulmonary Embolism/etiology* ; Soft Tissue Injuries/complications*

OBJECTIVETo analysis and discuss the early diagnosis and treatment of fat embolism syndrome caused by the injuries in Wenchuan earthquake happened in May 12th, 2008.

METHODSTo carry out dynamic blood and oxygen analysis and blood routine examination for the 13 fat embolism syndrome patients wounded in the earthquake, and combine with clinical features and early diagnosis, inject hydrocortisone injection, dextran 40 glucose injection and Dan Shen Root injection. Meanwhile, pay attention to supporting the respiratory function and correcting hypoxemia.

RESULTSOf 13 patients, 12 cases were rescued successfully, and the successful rate was 92.3%, while one cases died from respirometric failure with fat embolism syndrome and secondary hemorrhagic pneumonia.

CONCLUSIONSThe key to treating fat embolism syndrome is the early diagnosis and timely and accurate treatment. Supporting the respiratory function, correcting hypoxemia and early high-dose combination of hormone treatment are the effective treatment methods.

Adult ; Early Diagnosis ; Earthquakes ; Embolism, Fat ; diagnosis ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Wounds and Injuries ; complications

Fat embolism syndrome (FES) is a common and life-threatening clinical syndrome, which is a difficult problem frequently encountered in medical science, especially in forensic medicine and orthopaedics. FES would be easily mistaken or missed by forensic examiner due to the lack of the specific symptoms and signs. This article reviews the etiology, pathogenesis, pathology, the mechanism of death, as well as the advances of the forensic medicine diagnosis of FES with current literatures update.
Animals ; Disease Models, Animal ; Embolism, Fat/pathology* ; Forensic Pathology ; Fractures, Bone/complications* ; Humans ; Prognosis ; Rats ; Retrospective Studies ; Syndrome ; Wounds and Injuries/complications*

OBJECTIVETo discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma.

METHODSFrom July 2009 to July 2012, 30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept, included 20 males and 10 females with an average age of (34.03 ± 12.81) years old ranging from 20 to 60 years old; the ISS averaged (35.00 ± 12.81) points (ranged from 26 to 54 points). And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009, there were 23 males and 7 females with an average age of (34.23 ± 11.04) years old ranging from 18 to 65 years old. The ISS averaged (35.56 ± 11.04) points (ranged from 26 to 51 points). The age, gender, ISS, Gustilo classification, operation time, intraoperative blood loss, blood transfusion,postoperative complications and mortality rate were observed and compared.

RESULTSIn the damage control concept group,there were 28 cases surviving and 2 cases (6.7%) death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome, 1 case of multiple organ failure, 1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group, there were 22 cases surviving and 8 cases death(26.7%); 13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure, 2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age, gender, ISS, Gustilo classfication and complication (P > 0.05), however there were statistically significant differences in mortality rate, operation time, blodd loss, blodd transfusion between two groups (P < 0.05).

CONCLUSIONDamage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy, can improve survival rate and reduce complication.

Adolescent ; Adult ; Aged ; Embolism, Fat ; prevention & control ; Extremities ; injuries ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; prevention & control

Adrenal Cortex Hormones ; therapeutic use ; Adult ; Embolism, Fat ; drug therapy ; etiology ; Evidence-Based Medicine ; Fractures, Bone ; complications ; Humans ; Male ; Treatment Outcome

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.
Accidents, Traffic ; Embolism, Fat ; diagnosis ; diagnostic imaging ; Femoral Fractures ; complications ; diagnostic imaging ; Humans ; Intracranial Embolism ; diagnosis ; diagnostic imaging ; Male ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore ultra-structural changes of fat embolism syndrome (FES) in the lung. METHODS: Fat embolism animal model was developed by fat intravascular injection to the experimental rabbits. The rabbits were sacrificed after thrombosis immediately (0 h), 3 h, 8 h and 1 d, 2 d, 7 d, 14 d after thrombosis, respectively. Rabbits were injected with the same dose of saline in the control group. All experimental procedures were same in experimental and control groups. The animal model of fat embolism was validated using HE and Sudan III staining. Ultra-structural changes of lung were observed by using transmission electron microscopy. RESULTS: Ultra-structural changes in capillaries and small blood vessels were found in experimental group. Type II alveolar cells, related cells and organelles showed time-dependent changes. Lipid drops and inflammatory cells were not found in control group. Lamellar body did not show emptying phenomenon and the amount of lamellar body was normal. CONCLUSION The study could provide the theoretical principle for fat embolism casesin forensic pathology.
Animals ; Capillaries/ultrastructure* ; Disease Models, Animal ; Embolism, Fat/pathology* ; Epithelial Cells/pathology* ; Forensic Pathology ; Lung/ultrastructure* ; Microscopy, Electron, Transmission ; Pulmonary Embolism/pathology* ; Rabbits ; Staining and Labeling ; Time Factors ; Wounds and Injuries/complications*

PURPOSE: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. METHODS: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. RESULTS: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. CONCLUSION FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.
Adolescent ; Adult ; Central Nervous System Diseases ; etiology ; Early Diagnosis ; Embolism, Fat ; diagnosis ; etiology ; prevention & control ; Fractures, Bone ; complications ; Humans ; Hypoxia ; etiology ; Intensive Care Units ; statistics & numerical data ; Length of Stay ; statistics & numerical data ; Male ; Patient Outcome Assessment ; Time Factors ; Trauma Centers ; statistics & numerical data ; Young Adult