Cargando…

Rational design of secondary operation for penetrating head injury: A case report

Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the po...

Descripción completa

Detalles Bibliográficos
Autores principales: Yuan, Yi-Kai, Sun, Tong, Zhou, Yi-Cheng, Li, Xue-Pei, Yu, Hang, Guan, Jun-Wen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156957/
https://www.ncbi.nlm.nih.gov/pubmed/32171654
http://dx.doi.org/10.1016/j.cjtee.2019.12.004
_version_ 1783522318418444288
author Yuan, Yi-Kai
Sun, Tong
Zhou, Yi-Cheng
Li, Xue-Pei
Yu, Hang
Guan, Jun-Wen
author_facet Yuan, Yi-Kai
Sun, Tong
Zhou, Yi-Cheng
Li, Xue-Pei
Yu, Hang
Guan, Jun-Wen
author_sort Yuan, Yi-Kai
collection PubMed
description Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well.
format Online
Article
Text
id pubmed-7156957
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-71569572020-04-22 Rational design of secondary operation for penetrating head injury: A case report Yuan, Yi-Kai Sun, Tong Zhou, Yi-Cheng Li, Xue-Pei Yu, Hang Guan, Jun-Wen Chin J Traumatol Special Topic on Facial Fracture Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well. Elsevier 2020-04 2020-03-11 /pmc/articles/PMC7156957/ /pubmed/32171654 http://dx.doi.org/10.1016/j.cjtee.2019.12.004 Text en © 2020 Production and hosting by Elsevier B.V. on behalf of Chinese Medical Association. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Special Topic on Facial Fracture
Yuan, Yi-Kai
Sun, Tong
Zhou, Yi-Cheng
Li, Xue-Pei
Yu, Hang
Guan, Jun-Wen
Rational design of secondary operation for penetrating head injury: A case report
title Rational design of secondary operation for penetrating head injury: A case report
title_full Rational design of secondary operation for penetrating head injury: A case report
title_fullStr Rational design of secondary operation for penetrating head injury: A case report
title_full_unstemmed Rational design of secondary operation for penetrating head injury: A case report
title_short Rational design of secondary operation for penetrating head injury: A case report
title_sort rational design of secondary operation for penetrating head injury: a case report
topic Special Topic on Facial Fracture
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156957/
https://www.ncbi.nlm.nih.gov/pubmed/32171654
http://dx.doi.org/10.1016/j.cjtee.2019.12.004
work_keys_str_mv AT yuanyikai rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport
AT suntong rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport
AT zhouyicheng rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport
AT lixuepei rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport
AT yuhang rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport
AT guanjunwen rationaldesignofsecondaryoperationforpenetratingheadinjuryacasereport