Clinical Considerations in Initial Evaluation and Treatment of Hardhead Catfish Spine Puncture Wounds

A 17-year-old male presented to our ED complaining of pain and swelling at the base of the first metacarpal after attempting to remove a catfish from his fishing line 12 hours prior to arrival. Radiographic images demonstrated a foreign body (FB), which was detectable by ultrasound. Hand surgery was consulted and took the patient to the operating room for exploration and removal of two serrated radiopaque catfish spines that were deeply embedded in the left thumb. Conclusion. Penetrating injury from hardhead catfish (Ariopsis felis) spines can cause hidden FB, envenomation, infection, and secondary damage to nearby structures. Imaging should be done for these patients to ensure they obtain timely and complete extraction of the venomous structures. Surgery should be consulted for operative management to avoid damage on removal of the catfish spine remnants.

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Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/501601 ◽

1999 ◽

Vol 20 (02) ◽

pp. 110-114 ◽

Cited By ~ 45

Author(s):

Deniz Akduman ◽

Lynn E. Kim ◽

Rodney L. Parks ◽

Paul B. L'Ecuyer ◽

Sunita Mutha ◽

...

Keyword(s):

Operating Room ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Tertiary Care ◽

Hand Surgery ◽

Occupational Exposures ◽

Protective Equipment ◽

Care Hospital ◽

Exposure Rate ◽

Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

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Leg Impalement – A Rare Injury Pattern Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i10.2444 ◽

2021 ◽

Vol 11 (10) ◽

Author(s):

Gabriel Pina ◽

Maria Rita Vaz ◽

Ana Vaz ◽

Nuno Borralho

Keyword(s):

Foreign Body ◽

Operating Room ◽

Hospital Care ◽

High Energy ◽

Massive Hemorrhage ◽

Road Accident ◽

Body Region ◽

Rare Injury ◽

Foreign Body Removal ◽

Wound Debridement

Introduction: Impalement injuries are defined as rare, high-energy lesions caused by foreign bodies, usually steel bars or wooden objects, which pierce body cavities or extremities and remain interposed in the perforated body region. They usually occur with road accident or civil construction falls. Case Report:A 24-year-old male patient was admitted at the emergency department after a motorcycle accident, resulting a left leg impalement with a wooden object. A partial deep peroneal nerve palsy and a proximal third fibula fracture were observed. The foreign body removal and wound debridement were performed. The patient evolved favorably without complications, with complete neurological recovery and returning to his normal life activities. Discussion: Impalement injuries represent a challenge in pre-hospital care, emergency room, and operating room hospital care, due to its rarity and specificity: Type of object, anomalous foreign body location, and trajectory. There is a consensus that whenever possible, it should be removed in the operating room, due to the foreign body may be tamponing a major arterial laceration, thus preventing massive hemorrhage. Conclusion: Neurovascular injury exclusion, foreign body removal in the operating room, debridement, and antibiotic prophylaxis represent the treatment basis of these injuries. Keywords: Impalement, Trauma, Leg

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Optimising Hand Surgery during COVID-19 Pandemic

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835521500132 ◽

2021 ◽

Vol 26 (01) ◽

pp. 84-91

Author(s):

Shivangi Saha ◽

Suvashis Dash ◽

Mohammed Tahir Ansari ◽

Ashish Dhanraj Bichupuriya ◽

Amit Kumar Gupta ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Hand Surgery ◽

Patient Characteristics ◽

Operative Management ◽

Hand Injuries ◽

Care Needs ◽

Use Of Resources ◽

Flap Cover

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.

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PS01.087: SINGLE STEP TREATMENT OF ESOPHAGEL PERFORATION CAUSED BY HUGE FOREIGN BODY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.087 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 74-74

Author(s):

Soohwan Choi ◽

Jae Kil Park ◽

Seungkeun Yoon

Keyword(s):

Foreign Body ◽

Neck Pain ◽

Operating Room ◽

Esophageal Perforation ◽

Foreign Bodies ◽

Upper Esophageal Sphincter ◽

Single Step ◽

Thoracic Esophagus ◽

Endoscopic Assistance ◽

Esophageal Sphincter

Abstract Background If a clinician encounters a foreign body in thoracic esophagus, flexible endoscopy is the first treatment modality that comes up in mind. But if the foreign body is too huge to pass the upper esophageal sphincter or stuck in esophageal wall, removal is not easy and could result in iatrogenic injury. Furthermore, esophageal perforation is clinically fatal situation and mandates prompt surgical intervention. Here, we report our successful single step treatment of esophageal perforation caused by huge foreign body. The procedure proceeded in operating room with endoscopic assistance. Methods Medical chart review. Results 69 years old male patient admitted to emergency department complaining of neck pain. About 4 days ago, he had ingested a crab. Since then, foreign body sensation and neck pain had been persisted. Computed Tomography (CT) and endoscopy revealed perforation of cervical esophagus. We performed a surgical exploration. With left cervical collar incision, we were able to exposure the injured esophagus. Simultaneously, a gastroenterologist performed an endoscopic inspection. Foreign bodies had migrated to the thoracic esophagus. With endoscopic forceps, most of foreign bodies were removed through the patient's mouth (including the longest one, about 4centimeter; cm). But, 2.8cm sized foreign body was not able to pass the upper esophageal sphincter. Thus, the gastroenterologist pulled the foreign body to level of perforated esophagus and we removed it without difficulty. Finally, the gastroenterologist checked the total length of esophagus. There was no other perforation. Then, we did primary repair of esophagus. The patient discharged at post operation day 11 without complication. Conclusion In our case, some of foreign body was situated perpendicularly in thoracic esophagus. Therefore, it couldn’t pass the upper esophageal sphincter, which the longer one could. With endoscopic assistance in operating room, single step treatment (foreign body removal and perforation repair) was possible. In addition, full inspection of total length of esophagus was possible, simultaneously. We think this single step approach is feasible in terms of avoiding unnecessary thoracic approach and multistep procedures (endoscopy followed by surgery). Disclosure All authors have declared no conflicts of interest.

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Hand Therapy for Carpal Tunnel Syndrome Part II: Pre-Operative Considerations Surgical Technique and Post operative Therapy

The British Journal of Hand Therapy ◽

10.1177/175899830200700202 ◽

2002 ◽

Vol 7 (2) ◽

pp. 50-54 ◽

Cited By ~ 1

Author(s):

Jo Ellis ◽

Helen Mckenna ◽

Frank D Burke

Keyword(s):

Carpal Tunnel Syndrome ◽

Surgical Technique ◽

Carpal Tunnel ◽

Operative Therapy ◽

Hand Surgery ◽

Operative Management ◽

Hand Therapy ◽

Operative Care ◽

Operative Complications ◽

Tunnel Syndrome

Carpal tunnel decompression has become one of the most common procedures in hand surgery. This second paper on carpal tunnel decompression describes the pre-operative management of patients undergoing surgery, the procedure and the immediate post-operative care. It outlines the possible interventions for the minority of patients with post-operative complications.

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Detection of Foreign Bodies using Ultrasound: A Possible Pitfall

Canadian Journal of Plastic Surgery ◽

10.1177/229255039400200104 ◽

1994 ◽

Vol 2 (1) ◽

pp. 35-38 ◽

Cited By ~ 1

Author(s):

Bing Siang Gan ◽

Lawrence N Hurst ◽

H Brian Evans ◽

Donal Downey

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Hand Surgery ◽

Diagnostic Ultrasound ◽

Clinical Suspicion ◽

Ultrasound Scanning ◽

Flexor Tendons ◽

Anatomical Localization ◽

Wooden Foreign Body ◽

Exploratory Surgery

Recently, a number of reports have brought the use of ultrasound scanning in the detection of foreign bodies to the field of hand surgery. A case is presented in which ultrasound was not able to diagnose the presence of a large (3.5 × 0.5 × 0.5 cm) nonradiopaque wooden foreign body lying between the flexor tendons of the forearm. However, embedded in ultrasound gel, the piece could readily be identified. This report serves as a reminder that the anatomical localization of a foreign body amid structures with vastly different echogenicity from its surroundings (such as flexor tendons of the hand and forearm) may reduce the usefulness of diagnostic ultrasound and that in such circumstances clinical suspicion may be a more reliable indication for exploratory surgery.

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Ultrasound-guided removal of hypopharyngeal foreign body in the emergency department

Ultrasound ◽

10.1177/1742271x17704681 ◽

2017 ◽

Vol 25 (4) ◽

pp. 245-247

Author(s):

Nadia Maria Shaukat ◽

Alexis Lenz ◽

Poonam Desai

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Operating Room ◽

Ultrasound Guided ◽

Partial Denture ◽

Life Threatening ◽

Foreign Body Impaction

Foreign body impaction at the cricopharyngeal level can be a life-threatening emergency. While traditionally, removal of these is performed in the operating room setting, patients with relatively unstable airways or significant discomfort may require immediate extraction to prevent further injury. This is the case of an 85-year-old man who presented to the emergency department in significant discomfort following aspiration of a large partial denture. We report here the first known use of ultrasound in an emergent airway situation to rapidly localize and retrieve an aspirated foreign body.

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942 Outcome of Image Guided Intra-Articular Thumb Base Steroid Injections-Retrospective Study of Consecutive Patient Over 4 Years in A Plastic and Hand Surgery Unit in West Lothian, Scotland

British Journal of Surgery ◽

10.1093/bjs/znab259.707 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

N N Thazhathe Peedika ◽

P Goswami

Keyword(s):

Pain Relief ◽

Image Intensifier ◽

Hand Surgery ◽

The Elderly ◽

Operative Management ◽

Steroid Injections ◽

Image Guided ◽

Subjective Pain ◽

Significant Disability ◽

Hospital Management System

Abstract Introduction Osteoarthritis of the thumb base is a common condition. Usually effects the elderly population causing significant disability. Modalities of treatment of osteoarthritis which includes conservative measures, non-operative interventions, and surgery. In this study we endeavored to assess how effective are image guided steroid injections for base of thumb Osteoarthritis as assessed by subjective pain relief perceived by patient and what percentage of these patients proceed to operative treatment. Method Retrospective data between January 2015 and December 2018 of the patients who underwent Steroid injections to the Base of thumb joints (CMCJ and/or STTJ) for Osteoarthritis under image intensifier guidance was collected from Hospital management system –TRAK and eHealth services. Follow up of the patients were done for Maximum 1 to 5 years. Results A total number of 692 patients with thumb base osteoarthritis were included in the study of which 546 patients underwent Image guided steroid injection to the thumb base. The mean Age of patients was 64.5 years and the Female: Male ratio was 401:145. Mean number of injections each patient received- 3.25 (1 – 7 times). Pain relief after first, second and third injections were 3.15 months, 2.63 and 1.75 months, respectively. 127 (23.2% of injections patients) underwent trapeziectomy. Mean time between first injection & Surgery was 1.3yrs (6 months -2 years) Conclusions This study demonstrates the effectiveness of image guided steroid injections for thumb base osteoarthritis. Though about a quarter of these patients proceed to operative management, steroid injections can delay the same considerably.

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Allergic tonsillar polyp: an uncommon lesion

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204185 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1837

Author(s):

Anil A. Vare ◽

Rena A. Vare ◽

Sanjana U. Nair

Keyword(s):

Foreign Body ◽

Histopathological Examination ◽

Operative Management ◽

Clinicopathological Features ◽

Age Group ◽

Inclusion Cyst ◽

Specific Diagnosis ◽

Body Sensation ◽

Clinicopathological Study

Background: Tonsils are not so commonly affected by allergic lesions or polyps. In this study we attempt to elucidate the nature of tonsillar polyps.Methods: The present study is a hospital based retrospective clinicopathological study in which a total of nine cases whose histopathological slides were reviewed and patient follow up was obtained. Results: There were 5 males and 4 females between the age group of 15 to 30 years. Most of the cases presented with complaints of repeated throat pain, difficulty swallowing, foreign body sensation in throat and dry irritating cough. On examination a pedunculated sessile mass in seen protruding from the surface of the palatine tonsil usually unilateral. The clinical differentials included were tonsillar lipoma, haemangioma, lymphangioma, inclusion cyst and neoplasm. Based on histopathological examination following tonsillectomy with polypectomy a conclusion of allergic polyp was made and clinical follow up information of patients were obtained post-operatively. In this series we examine the clinicopathological features of polypoidal lesions of tonsils whose specific diagnosis was obtained after histopathological examination.Conclusions: A histopathological examination must be obtained in all cases of tonsillar polyps for proper post-operative management.

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Tracheobronchial foreign body aspiration in children aged ≤ 2 years: the use of ﬂexible bronchoscopy and urology stone retrieval basket in emergency setting

10.22514/sv.2021.014 ◽

2021 ◽

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Main Bronchus ◽

Pediatric Population ◽

Operation Time ◽

Operative Management ◽

Flexible Bronchoscopy ◽

Emergency Setting ◽

Flexible Bronchoscope ◽

Pediatric Airway

Objective: Tracheobronchial aspiration of foreign body in children is an emergency that can lead to major complications. In the last years flexible bronchoscopy has gained popularity for foreign bodies retrieval in the pediatric population, yet the small size of the pediatric airway and of the flexible bronchoscope channel limit the availability of instruments during the procedure. Aim of this paper is to describe our experience in treating foreign bodies tracheobronchial aspiration in children aged 2 years or less by means of flexible bronchoscope and an urology stone retrieval basket. Methods: A review of endoscopic foreign bodies removal by means of flexible bronchoscopy and urology stone retrieval basket has been carried out in children ≤ 2 years that presented at the Emergency Room of our hospital from 2005 to 2019. In the paper, we analyze characteristics of patients, timing of bronchoscopy, instruments and operative management. Results: There were 25 patients with a mean age of 20 ± 3.8 months. Organic material was the most frequent observed foreign body. Association of main bronchus and distal bronchi was the preferred site of the foreign body in 19 patients and the right side of the bronchial tree was involved in 17 cases. Complications occurred in one case. Mean operation time was 37 ± 20 minutes. Conclusions: The use of flexible bronchoscope can be helpful in handling endoscopic removal of tracheobronchial foreign bodies in toddlers. The use of the urology stone retrieval basket resulted very effective in all shapes of foreign bodies and/or when the object was located in the distal bronchi.

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