A closed internal degloving injury is a soft tissue injury, in which the subcutaneous tissue is ripped from the underlying fascia. In rare cases, a closed internal degloving injury can lead to hemorrhagic shock. A 79-year-old woman was brought to the emergency department following an auto-pedestrian accident, in which she was hit by a car. She was in a stupor and was hypotensive. The initial evaluation was unremarkable. During management, the patient required the transfusion of a large volume of blood, and vasoactive agent. Abdominal computed tomography revealed a large hematoma in her lower back and gluteal area and she was diagnosed with a closed internal degloving injury. Missed or delayed diagnosis of this type of injury may result in a significant increase in transfusion requirements and irreversible hemorrhagic shock.
Aged ; Contusions ; Delayed Diagnosis ; Emergency Service, Hospital ; Fascia ; Female ; Hematoma ; Humans ; Shock, Hemorrhagic ; Soft Tissue Injuries ; Stupor ; Subcutaneous Tissue

BackgroundHand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.

MethodsSixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.

ResultsThe normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.

ConclusionsSports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.

Adult ; Athletic Injuries ; diagnosis ; surgery ; Female ; Hand Deformities ; diagnosis ; surgery ; Humans ; Ligaments ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Metacarpophalangeal Joint ; diagnostic imaging ; surgery ; Middle Aged ; Soft Tissue Injuries ; diagnostic imaging ; surgery ; Tendon Injuries ; diagnostic imaging ; surgery ; Thumb ; abnormalities ; surgery

Morel-Lavallée is a rare lesion caused by post-traumatic soft tissue injury. It usually occurs around the greater trochanter, and it occurs very rarely in the lumbar region. It is often difficult to be diagnosed in the emergency room. Delayed diagnosis may result in the need for open surgery. The authors report a patient with extensive multiple Morel-Lavallée lesions in the thoracolumbar, buttock, and thigh after trauma and provide a literature review.
Buttocks ; Delayed Diagnosis ; Emergency Service, Hospital ; Femur ; Humans ; Lumbosacral Region ; Soft Tissue Injuries ; Thigh

Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for ante- rolateral thigh (ALT) flap. Oblique branch of LCFA is an alternative pedicle that can be used in micro- vascular surgery. According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction. Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident, who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.
Accidents, Traffic ; Buttocks ; Femoral Artery ; surgery ; transplantation ; Femur ; Graft Survival ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Myocutaneous Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; methods ; Risk Assessment ; Soft Tissue Injuries ; diagnosis ; surgery ; Surgical Flaps ; blood supply ; transplantation ; Thigh ; surgery ; Wound Healing ; physiology

A 31-year-old male motorcyclist presented with prepatellar swelling of the left knee after a collision with a car. Magnetic resonance imaging of the knee showed no bony or ligamentous injury to the knee. Instead, a well-defined, thin-walled, T2-weighted hyperintense fluid collection with internal septations was identified in a prefascial location overlying the left patella and patellar tendon. The findings were in keeping with those of a Morel-Lavallée lesion, a closed internal degloving injury. Morel-Lavallée lesions are occasionally encountered after a blunt soft-tissue trauma. The presentation and imaging features are discussed.
Adult ; Compression Bandages ; Humans ; Knee Injuries ; diagnosis ; therapy ; Magnetic Resonance Imaging ; methods ; Male ; Physical Therapy Modalities ; Soft Tissue Injuries ; diagnosis ; therapy ; Trauma Severity Indices

Acute rhinosinusitis can usually be managed by appropriate medical therapy, but it may also extend to the periorbital area in some complicated cases. Periorbital necrotizing fasciitis is uncommon among orbital complications, but can be fatal if it leads to soft tissue infection characterized by extensive necrosis and gas formation in the fascia and subcutaneous tissue. Immunocompromised states such as old ages, diabetes mellitus, alcoholics, and chronic renal failure have been reported to be predisposing factors, but the disease has also been detected in healthy patients. If proper treatment is not performed at the right time, necrotizing fasciitis can lead to systemic toxicity, multisystem organ failure, and eventual death. Therefore, early diagnosis and treatment are important. We report a case of periorbital necrotizing fasciitis that occurred in a healthy 30-year-old male patient with acute rhinosinusitis, which was treated with a combination of intravenous antibiotics and debridement of necrotic tissue and local wound management.
Adult ; Alcoholics ; Anti-Bacterial Agents ; Causality ; Debridement ; Diabetes Mellitus ; Early Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Kidney Failure, Chronic ; Male ; Necrosis ; Orbit ; Sinusitis ; Soft Tissue Infections ; Subcutaneous Tissue ; Wounds and Injuries

OBJECTIVES: To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. METHODS: Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. RESULTS: Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. CONCLUSIONS Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury.
Accidents, Traffic ; Acetabulum/injuries* ; Death ; Forensic Pathology ; Fractures, Bone/diagnosis* ; Fractures, Comminuted/diagnosis* ; Humans ; Ischium/injuries* ; Pelvic Bones/injuries* ; Soft Tissue Injuries/diagnosis* ; Spinal Fractures/diagnosis*

20-year-old man presented to our emergency department after he was hit by a forklift. He developed haemorrhagic shock from a subcutaneous haematoma in his left thigh and required monitoring in the surgical intensive care unit. He stabilised with aggressive fluid resuscitation with crystalloids and blood transfusion. The recovery was complicated by an infection of the subcutaneous haematoma. Following open drainage of the infected subcutaneous haematoma, he improved and was discharged. To the best of our knowledge, this is the first reported case of a subcutaneous haematoma causing haemorrhagic shock.
Accidents, Traffic ; Diagnosis, Differential ; Hematoma ; complications ; diagnosis ; Humans ; Male ; Shock, Hemorrhagic ; diagnosis ; etiology ; Soft Tissue Injuries ; complications ; diagnosis ; Young Adult

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.
Adult ; Aged ; Antivenins/administration & dosage ; Combined Modality Therapy ; Compartment Syndromes ; Debridement/*methods ; Disease Management ; Edema/etiology ; Female ; Humans ; Male ; Middle Aged ; Necrosis ; *Practice Guidelines as Topic ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; Skin/pathology ; Skin Transplantation/*methods ; Snake Bites/complications/*diagnosis/pathology/*surgery ; Snake Venoms/adverse effects ; Soft Tissue Injuries/etiology/*pathology/surgery ; Treatment Outcome ; Wound Healing/physiology

Ultrasonography of the postoperative musculoskeletal system plays an important role in the Epub ahead of print accurate diagnosis of abnormal lesions in the bone and soft tissues. Ultrasonography is a fast and reliable method with no harmful irradiation for the evaluation of postoperative musculoskeletal complications. In particular, it is not affected by the excessive metal artifacts that appear on computed tomography or magnetic resonance imaging. Another benefit of ultrasonography is its capability to dynamically assess the pathologic movement in joints, muscles, or tendons. This article discusses the frequent applications of musculoskeletal ultrasonography in various postoperative situations including those involving the soft tissues around the metal hardware, arthroplasty, postoperative tendons, recurrent soft tissue tumors, bone unions, and amputation surgery.
Amputation ; Arthroplasty ; Artifacts ; Diagnosis ; Joints ; Magnetic Resonance Imaging ; Muscles ; Musculoskeletal System* ; Postoperative Care ; Soft Tissue Infections ; Soft Tissue Injuries ; Tendons ; Ultrasonography*