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Çakaroğlu M, Ergani HM, Ünlü RE. Youngest hand injury during cesarean delivery: A case report. HAND SURGERY & REHABILITATION 2024; 43:101656. [PMID: 38367769 DOI: 10.1016/j.hansur.2024.101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
An emergency cesarean surgery resulted in extensor tendon lacerations in a 27-week-old preterm fetus. This injury is unique because fetal hand lacerations rarely occur, and to the best of our knowledge, this is the youngest case of hand injury during cesarean delivery reported in the literature. This case report sets the framework for a more in-depth investigation of the incidence and treatment options for fetal lacerations, with an emphasis on the less common but clinically important hand lacerations that can occur during cesarean section. LEVEL OF EVIDENCE: Therapeutic IV.
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Affiliation(s)
- Melih Çakaroğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey; Sağlık Bilimleri University, Istanbul, Turkey
| | - Ramazan Erkin Ünlü
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey; Sağlık Bilimleri University, Istanbul, Turkey
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Har-Shai L, Kreichman R, Kedar R, Osovsky M, Chen R, Lavi I, Metanes I, Segal M, Ofek SE, Mattar S, Hassan S, Kramer A, Bryzgalin L, Ad-El D, Sagi-Dain L, Lavie O, Har-Shai Y. Risk factors associated with accidental fetal skin lacerations during cesarean delivery. Int J Gynaecol Obstet 2023; 160:131-135. [PMID: 35598118 DOI: 10.1002/ijgo.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 05/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify risk factors associated with accidental fetal skin lacerations (AFL) during cesarean section (CS). METHODS This retrospective cohort study was obtained from the registry of two large medical centers between 2014 and 2019. The study group comprised all newborns identified with AFL. The rates of various potential risk factors were compared between the study group and a group of CS at which no AFL had occurred (the control group). RESULTS Of the 14 666 CS deliveries, 48 cases of AFL (0.33%) were documented, 52% of these following urgent CS. Compared with the control group (n = 14 618), the only risk factors associated with AFL were premature rupture of membranes (PROM) (odds ratio [OR] 5.38, 95% convidence interval [CI] 2.97-9.74) and meconium-stained amniotic fluid (OR 6.50, 95% CI 2.55-16.54). In subgroup analysis by CS urgency, no significance for these factors was noted in elective CS group; but higher rates of both PROM and meconium-stained amniotic fluid were noted in the AFL during urgent CS (OR 14.23, 95% CI 6.30-32.16 and OR 15.36, (95% CI 5.65-41.75, respectively). CONCLUSIONS During urgent CS, the surgeon should bear in mind that the presence of PROM or meconium-stained amniotic fluid should prompt extra care and application of preventive measures to decrease the rates of AFL.
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Affiliation(s)
- Lior Har-Shai
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center-Beilinson Campus, Petach-Tikva, Israel
| | - Rita Kreichman
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Reuven Kedar
- Departments of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Micky Osovsky
- Neonatal Department, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
| | - Rony Chen
- Department of Obstretrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
| | - Idit Lavi
- Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Issa Metanes
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Miriam Segal
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Sar-El Ofek
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center-Beilinson Campus, Petach-Tikva, Israel
| | - Samar Mattar
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Samer Hassan
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Aviv Kramer
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Leonid Bryzgalin
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel
| | - Dean Ad-El
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center-Beilinson Campus, Petach-Tikva, Israel
| | - Lena Sagi-Dain
- Departments of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Departments of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Yaron Har-Shai
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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Esposito C, Escolino M, Paternoster M, Buccelli C, Graziano V, Falco M, Alicchio F, Cerulo M, Settimi A, Savanelli A. Fetal laceration during caesarean section and its medico-legal sequelae. MEDICINE, SCIENCE, AND THE LAW 2015; 55:97-101. [PMID: 24644228 DOI: 10.1177/0025802414526181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fetal laceration is a recognized complication of caesarean delivery. The aim of this study was to investigate the incidence, type, location, risk factors and long-term consequences of accidental fetal incised wounds during caesarean delivery. During a five-year period, we observed 25 cases of fetal lacerations caused by the scalpel during hysterotomy. In 20 of these cases, we observed these lesions as consultants for the Neonatologic Care Unit; the other five cases came under our care after an insurance claim for damages against the gynaecologist. All the infants had a lesion located to the head. In only 5 of the 25 cases the lesion was reported in the operative summary, and only 16 of the 25 mothers had signed an informed consent before surgery. With regard to the 20 cases diagnosed at the Neonatologic Care Unit, the lesion was closed using single stitches in nine cases, and with biological glue in 11 cases. Concerning the five cases that underwent legal proceedings against the gynaecologist, a clinical examination was performed by an expert in Public Health and Social Security in collaboration with a paediatric surgeon to evaluate the degree of biological damage. In all five cases, the result of the legal challenge was monetary compensation for the physical and moral damage caused by the gynaecologists to the patients and their parents. Accidental fetal lesions may occur during caesarean delivery; the incidence is significantly higher during emergency caesarean delivery compared to elective procedures. Patients should sign an informed consent in which they should be informed about the risk of the occurrence of fetal lacerations during caesarean delivery in order to avoid legal complications.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Mariano Paternoster
- Department of Public Health and Social Security, Federico II University of Naples, Italy
| | - Claudio Buccelli
- Department of Public Health and Social Security, Federico II University of Naples, Italy
| | - Vincenzo Graziano
- Department of Public Health and Social Security, Federico II University of Naples, Italy
| | - Marianna Falco
- Department of Public Health and Social Security, Federico II University of Naples, Italy
| | - Francesca Alicchio
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Antonio Savanelli
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
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Abstract
Extensor tendon injuries in the pediatric population require careful evaluation and treatment. This article focuses on the differences in injury type and treatment of pediatric versus adult extensor tendon injuries. A detailed history and physical examination is crucial in the management of extensor tendon injuries of the young patient. Treatment of pediatric extensor tendon injuries depends largely on the site of injury. A majority of these injuries may be treated with splinting or primary repair. Treatment methods that require high compliance must be adjusted for the young child.
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Lightdale-Miric N, Iantorno S, Meisel E. Delayed reconstruction of a flexor digitorum profundus tendon lacerated during cesarean delivery: case report. J Hand Surg Am 2014; 39:2464-7. [PMID: 25442771 DOI: 10.1016/j.jhsa.2014.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
We present a case of primary tendon grafting in a 14-month-old infant for an index finger flexor digitorum profundus tendon laceration sustained during cesarean section with excellent functional results at 2-year follow-up.
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Affiliation(s)
- Nina Lightdale-Miric
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Stephanie Iantorno
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Erin Meisel
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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