The author experienced 96 cases of eyeball perforation from January 1980 to May 1982. Of those evaluated 24 cases of severe penetrating injuries involving vitreous gel were treated with pars plana vitrectomy. The conclusions were as follows: 1. Visual improvement was achieved in 45.B%, of the 24 patients with ocular penetrating injury treated by pars plana vitrectomy. 2. The prognosis was poorer in cases with scleral or corneoscleral injury than corneal penetrating injury. 3. The final visual prognosis was poorer in the 8 cases with large scleral laceration (more than 8mm) than in the other 16 cases. The visual acuity was limited to hand motion or less in 12 cases. 4. Those patients who were operated on between 2 weeks and 6 weeks after the injury had a better prognosis than others.
Eye Injuries/*surgery ; Humans ; Prognosis ; *Vitrectomy ; Wounds, Penetrating/*surgery

We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient.
Adhesives ; Angiography, Digital Subtraction ; Carotid Arteries ; Cavernous Sinus ; Decompression ; Foreign Bodies ; Head Injuries, Penetrating ; Hemostasis ; Humans ; Skull Base ; Wounds, Penetrating

PURPOSE: Scleral buckles are frequently performed as an additional procedure in perforated ocular injury surgery, but little is known about their independent effect after ocular trauma. The authors made a posterior penetrating ocular injury model in rabbits to evaluate the isolated role of primary scleral buckle placement. METHODS: Twenty eyes underwent surgery. The penetrating injury consisted of two 5 mm circumferential incisions placed five clock hours apart and 7 mm behind the limbus. A segmental scleral buckle was placed over a randomly chosen penetrating injury site after wound closure. The degree of the fibrous proliferation, traction, and the presence of retinal detachment were evaluated on follow-up examination. After enucleation and fixation, tissue sectioning was performed including injury sites. The greatest dimension of the fibrous proliferation at both wound sites was measured. RESULTS: Two eyes were excluded from the study due to unsuccessful buckling. Four eyes developed a retinal detachment. The remaining 14 eyes showed varying degrees of proliferation and traction on the retina. The greatest dimension of the fibrous proliferation at the buckle site (1.69 +/- 0.29 mm) was significantly different from that at the non-buckle site (2.07 +/- 0.37 mm, P<0.05). CONCLUSION: Primary scleral buckle placement at the time of surgical repair reduces vitreous traction and decreases the degree of fibrous proliferation.
Eye Injuries, Penetrating* ; Follow-Up Studies ; Methods ; Rabbits ; Retina ; Retinal Detachment ; Tissue Fixation ; Traction ; Wounds and Injuries

PURPOSE: In Korea, most abdominal penetrating wounds are caused by stab wounds rather than gun-shot wounds. However, not many studies have been performed on stab injuries and their epidemiologic characteristics. Disagreements of opinions of obligatory surgical exploration and conservative treatment exist, and this subject is still being debated. Therefore, the authors studied the epidemiologic characteristics of abdominal stab wound patients visiting the emergency department and reviewed the proportion of patients that received non-therapeutic surgery and conservative treatment. METHODS: This study included patients visiting the emergency department with abdominal stab wounds. A retrospective chart review was done on the abdominal stab wound patients. Sex, age, cause of injury, location of wound, initial vital signs, operation results, injured organs and CT & LWE results were reviewed. RESULTS: The median age of the 121 patients was 40.9 years, of these patients, 88 were males, of which 52 (43.0%) were drunken. Of the patients that received non-therapeutic operations, only 3 patients (15.0%) were drunken, significantly lower than the therapeutic operation group. For the location of the wound, most patients were injured in the right and left upper quadrants, 27 patients each. The most common injured organ was the small bowel; 13 patients were injured in the small bowel. With abdominal CT scans and local wound explorations together, the results exhibited a sensitivity of 97%, a specificity of 44%, a positive predictive value of 56%, and a negative predictive value of 95%. CONCLUSION: In our study, the sensitivity was 97% when CT & LWE were performed together; thus we can conclude that CT and LWE can be used together to select the treatment method. Although in our study, the surgical indications in abdominal stab wound patients is not sufficient, our results showed a higher rate of non-therapeutic surgery compared to previous studies. Therefore, more research is needed to prevent unnecessary laparotomies in hemodynamically-stable patients without symptoms.
Abdomen ; Emergencies ; Emergency Medicine ; Humans ; Korea ; Laparotomy ; Male ; Retrospective Studies ; Sensitivity and Specificity ; Vital Signs ; Wounds, Penetrating ; Wounds, Stab

OBJECTIVE: Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. METHODS: The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. RESULTS: The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. CONCLUSION: PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.
Atherosclerosis ; Balkan Peninsula ; Blood Vessels ; Brain Injuries ; Brain ; Bulgaria ; Cadaver ; Chronic Disease ; Delivery of Health Care ; Ethnic Groups ; Facial Bones ; Fatty Liver ; Forensic Sciences ; Greece ; Head Injuries, Penetrating ; Humans ; Mortality ; Parietal Bone ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Skull ; Skull Base ; Suicide ; Toxicology ; Wounds, Gunshot

OBJECTIVE: To evaluate the application value for the prognosis of mechanical ocular injury cases using ocular trauma score (OTS). METHODS: Four hundred and eleven cases of mechanical ocular trauma were retrospectively reviewed. Of the 449 eyes, there were 317 closed globe injury and 132 open globe injury. OTS variables included numerical values as initial visual acuity, rupture, endophthalmitis, perforat- ing or penetrating injury, retinal detachment and relative afferent pupillary block. The differences be- tween the distribution of the final visual acuity and the probability of standard final visual acuity were compared to analyze the correlation between OTS category and final visual acuity. The different types of ocular trauma were compared. RESULTS: Compared with the distribution of final visual acuity in standard OTS score, the ratio in OTS-3 category was statistically different in present study, and no differences were found in other categories. Final visual acuity showed a great linear correlation with OTS category (r = 0.71) and total score (r = 0.73). Compared with closed globe injury, open globe injury was generally associated with lower total score and poorer prognosis. Rupture injury had poorer prognosis compared with penetrating injury. CONCLUSION The use of OTS for the patients with ocular trauma can provide re- liable information for the evaluation of prognosis in forensic medicine.
Eye Injuries/diagnosis* ; Forensic Medicine ; Humans ; Probability ; Prognosis ; Retrospective Studies ; Rupture ; Trauma Severity Indices ; Visual Acuity ; Wounds, Penetrating

Mediastinal impalement injuries are uncommon and often fatal. There have been very few reported cases of survival following mediastinal impalement. Patients who present with these injuries always undergo operative intervention regardless of their underlying haemodynamic status or associated injuries. We herein present a case of mediastinal impalement injury, where a sheet of fibreglass had fractured the manubrium and entered the anterior mediastinum with no associated great vessel injury. The fibreglass sheet was removed via a partial sternotomy and the patient made an uneventful postoperative recovery.
Adult ; Foreign Bodies ; surgery ; Glass ; Humans ; Male ; Mediastinum ; surgery ; Occupational Injuries ; Radiography, Thoracic ; Sternotomy ; Thoracic Injuries ; surgery ; Tomography, X-Ray Computed ; Wounds, Penetrating ; surgery ; Wounds, Stab ; surgery

OBJECTIVES: To determine the demographics, incidence, etiology, and severity of pediatric ocular trauma cases seen in a tertiary hospital and to establish the visual outcomes of these cases using the Ocular Trauma Score (OTS).
METHODS: Pediatric patients, aged 0-18, who came to the emergency clinic for ocular trauma between January to April 2012 were included in the study. They were examined on initial consult and computed for the OTS by converting the OTS variables into OTS categories. They were followed up after 1, 2, and 3 months. The distribution of percentage of final visual acuity was compared with the OTS.
RESULTS: There was a male predominance (76%) occurring mostly in the 2-6 year age group (37%). Injuries were predominantly accidental (91%), occurring at home (72%), and frequently caused by blunt trauma (55%), followed by penetrating injuries (21%). Majority (76.2%) had no impairment while 14% had severe visual disability after three months. Eighty-three percent corresponded to the OTS proposed final visual acuities and the remaining 17% fell into the category one below or above the proposed final visual acuity.
CONCLUSION: Ocular trauma is a common cause of visual impairment in children and can be prevented. There should be preventive measures, better supervision, public education, and aggressive and prompt management to improve visual outcomes.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Tertiary Care Centers ; 2-toluenesulfonamide ; Eye Injuries ; Visual Acuity ; Eye ; Wounds, Penetrating ; Vision Disorders

Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility. In this case report, we describe the successful outcome of a case of double thoracic impalement by two steel tors, of which one steel tor had impaled two patients simultaneously. The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself, till the definitive management of the impaled thoracic objects. Thoracic impalement injuries are dramatic and appear very challenging. However presence of mind of the managing team, coordinated team effort and availability of adequate facilities can lead to a successful outcome.
Humans ; Thoracic Injuries ; Wounds, Penetrating

Intraorbital wooden foreign bodies may present difficulties in diagnosis due to their radiolucent nature. Delayed recognition and management can cause significant complications. We present a case report that demonstrates these problems and the sequela that can follow. A 56-year-old man presented with a 3-cm laceration in the right upper eyelid, sustained by a slipping accident. After computed tomography (CT) scanning and ophthalmology consultation, which revealed no fractures and suggested only pneumophthalmos, the wound was repaired by a plastic surgery resident. Ten days later, the patient’s eyelid displayed signs of infection including pus discharge. Antibiotics and revisional repair failed to solve the infection. Nearly 2 months after the initial repair, a CT scan revealed a large wooden fragment in the superomedial orbit. Surgical exploration successfully removed the foreign body and inflamed pocket, and the patient healed uneventfully. However, the prolonged intraorbital infection had caused irreversible damage to the superior rectus muscle, with upgaze diplopia persisting 1 year after surgery and only minimal muscle function remaining. We report this case to warn clinicians of the difficulties in early diagnosis of intraorbital wooden foreign bodies and the grave prognosis of delayed management.
Anti-Bacterial Agents ; Delayed Diagnosis ; Diagnosis ; Diplopia ; Early Diagnosis ; Eye Foreign Bodies ; Eye Injuries, Penetrating ; Eyelids ; Foreign Bodies* ; Humans ; Lacerations ; Middle Aged ; Ophthalmology ; Orbit ; Prognosis ; Suppuration ; Surgery, Plastic ; Tomography, X-Ray Computed ; Wounds and Injuries