7.Pulmonary hemorrhagic infarction due to fat embolism and thromboembolism after maxillofacial plastic surgery: a rare case report.
Dong-hua ZOU ; Yu SHAO ; Jian-hua ZHANG ; Zhi-qiang QIN ; Ning-guo LIU ; Ping HUANG ; Yi-jiu CHEN
Journal of Forensic Medicine 2012;28(5):375-378
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*
10.Trauma and pulmonary thromboembolism: an experimental study on their correlation.
Gang GUO ; Ying KANG ; Xu LI ; Ze-hao CAI ; Jiong-hao CHEN ; Gang WANG ; Guo-xian PEI
Chinese Journal of Traumatology 2007;10(4):237-241
OBJECTIVETo investigate the correlation between trauma and pulmonary thromboembolism.
METHODSComminuted fractures and extensive soft-tissue contusion at both hind limbs were made by a falling weight from a height in 16 rabbits. Lung perfusion scanning was performed to obtain the radioactivity counts before trauma, at 1 h, 48 h and 96 h after trauma. All the data were divided into 4 groups based on the above 4 time points. The rabbits were sacrificed when positive findings on the pulmonary perfusion scanning appeared. Their lungs were harvested to be paraffin-embedded and stained with hematoxylin-erosin method for histological examination of thromboembolism. The randomized block design ANOVA and the method of least significant difference (LSD) were used for statistical analysis of the radioactivity counts.
RESULTSThe histological findings showed that pulmonary embolism developed in 6 of the 16 rabbits (37.5%). Five of the 6 pulmonary embolism rabbits presented neither clinical symptoms nor positive pulmonary embolism manifestations in the lung perfusion scanning. A significant difference was found in lung perfusion radioactivity between the pre-traumatic, post-traumatic 1h groups and post-traumatic 48 h and 96 h groups(P less than 0.05).
CONCLUSIONSFractures of the hind limbs accompanied with extensive soft-tissue contusion may cause pulmonary micro-embolism that is not sensitive to lung perfusion scanning and tends to have no clinical symptoms. Pulmonary embolism development may take more than two days after trauma.
Animals ; Female ; Fractures, Bone ; complications ; Male ; Pulmonary Embolism ; etiology ; Rabbits ; Wounds and Injuries ; complications
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