Sub-decapitation in suicidal chainsaw injury: report of a rare case and operative management

A stepwise approach to chainsaw kickback injury of the nasoorbital complex: a case-based meta-narrative review

PURPOSE

This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review of English, French, and German literature indexed in PubMed, Embase, and the Cochrane Library up to January 8, 2024, accompanies the case report.

METHODS

This was a case report combined with a comprehensive review based on the 2011 Oxford Centre for Evidence-Based Medicine's highest and most recent level of evidence (LoE) and highest recommendation grade (RG). Rigorous selection criteria were applied.

RESULTS

The patient had an open nasal fracture, complex lacerations, and avulsion of the left eyelid, lateral orbital wall and lateral rectus muscle. Staged surgical interventions comprised repositioning and fixation of the fractured nose, buccal mucosal grafting for nasal mucosa and conjunctiva repair, titanium mesh and polydioxanone sheet for lateral orbital wall reconstruction, and subsequent muscle and eyelid repair. The second intervention 3 months postsurgery addressed lateral ectropion, nasal dorsal hump, and nasolacrimal system issues. Despite the rarity of such injuries, evidence-based discussions were conducted.

CONCLUSIONS

Complex nasoorbital trauma resulting from chainsaw kickback necessitates a meticulous, staged surgical approach. The inside-out technique proved effective in addressing various challenges. This article concludes with evidence-based recommendations, highlighting the importance of adapting established principles to unique nature of these injuries.

Methodology for determining accidental versus intentional injury afflicted by a chainsaw

Forensic analysis is often required to determine whether an injury was inflicted intentionally or accidentally. We have developed a method for addressing this issue in the case of an injury to a limb inflicted by a chainsaw. We discuss the potential use of this methodology to the more general case of injuries inflicted by power tools.