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Fremery A, Beguinot E, Franchi A, Douchet M, Tertre V, Hamiche K, Adenis A, Pujo JM, Kallel H. Epidemiologic analysis and mortality outcome of firearm injuries in French Guiana (2016-2019). Eur J Trauma Emerg Surg 2024; 50:1649-1659. [PMID: 38512419 PMCID: PMC11458668 DOI: 10.1007/s00068-024-02499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND French Guiana (FG) is a French territory located in South America with the highest rate of armed assaults. FG presents a poorly developed road system and a young and precarious population that makes the geographical and socio-demographic characteristics specific. No data concerning the firearm injury management are available in this country. Studying thesis trauma could permit to improve the management of victims. The objective of this study is to investigate the epidemiology of firearm injuries in FG, to define characteristics of the victims, and to assess factors associated with death. These identified factors could enable target primary prevention and intensification of medical management. METHODS From January 2016 to December 2019, we conducted a retrospective study at the Cayenne General Hospital (CGH), including all patients admitted for firearm injuries in the emergency department, the medical emergency and resuscitation service, and the forensic service. A bivariate analysis was performed to assess relevant clinical data that were entered into a logistic regression model to assess factors associated with death. RESULTS A total of 871 files were analyzed concerning 340 patients included after cross-checking. Victims were mainly males (90%) and young (30 ± 11 years old). The injury occurred mainly at night (60%), in a context of assaults (83%) and with long-barreled guns (82%). Among the 290 patients managed at the CGH, 60% were hospitalized including 12% that were in the intensive care unit, 41% that required surgical treatment, and 7% that died in hospital. The overall average length of stay was 10 ± 18 days. Overall mortality (n = 71, 21%) is statistically associated with male gender (p = 0.007) and suicide context (p < 0.001). In multivariate analysis, the sites of wounds (head and neck, thorax; p < 0.001) as well as induced organ injuries (neurological, respiratory, and vascular; p < 0.005) were independent factors associated to mortality. CONCLUSIONS This work underlines the high incidence of ballistic trauma in FG. This mainly involves a young and male population linked to the use of long arms and assaults. Despite the geographical difficulties of the territory and the technical platform deficits (no neurosurgery, no cardiothoracic surgery, no interventional radiology), the mortality is comparable to other studies, but remains more than twice as high as in mainland France. Finally, despite a change in legislation restricting access to firearms, our results show that gunshot firearm injuries remain a major public health concern requiring greater political actions.
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Affiliation(s)
- Alexis Fremery
- Emergency Department, Cayenne General Hospital, French Guiana, France.
- French Guiana University, French Guiana, France.
| | - Elliott Beguinot
- Emergency Department, Cayenne General Hospital, French Guiana, France
| | - Angélique Franchi
- Forensic Medical Unit, Cayenne General Hospital, French Guiana, France
| | - Mathilde Douchet
- Emergency Department, Cayenne General Hospital, French Guiana, France
| | - Victor Tertre
- Emergency Department, Cayenne General Hospital, French Guiana, France
| | - Karim Hamiche
- Forensic Medical Unit, Cayenne General Hospital, French Guiana, France
| | - Antoine Adenis
- French Guiana University, French Guiana, France
- CIC INSERM1424, Cayenne General Hospital, French Guiana, France
| | - Jean Marc Pujo
- Emergency Department, Cayenne General Hospital, French Guiana, France
- French Guiana University, French Guiana, France
| | - Hatem Kallel
- French Guiana University, French Guiana, France
- Intensive Care Unit, Cayenne General Hospital, French Guiana, France
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Singh S. Delayed Surgical Intervention in Cranio-Maxillofacial Splinter Injury: Report of a Case and A Literature Review. J Maxillofac Oral Surg 2024; 23:394-401. [PMID: 38601233 PMCID: PMC11001846 DOI: 10.1007/s12663-023-02061-9] [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: 10/04/2022] [Accepted: 11/07/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction In the context of Indian combat scenario, maxillofacial injuries from gunshots are uncommon. Methods The first section of this study is a case report of a rare instance of metal foreign bodies that were lodged in the parapharyngeal space, deeper to the deep lobe of the parotid right next to the carotid space in the neck. The second section focusses on the unique treatment for blast injuries as well as the variety of imaging procedures that are readily available to assist with surgery, such as plain film, CT, angiography, and occasionally MR imaging. Result and Conclusion According to the study, understanding the pertinent anatomy, precise imaging of the penetrating object in relation to vital structures, meticulously planned and conducted surgical removal of the foreign body, and repair of damaged structures are the key elements of a successful treatment.
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Affiliation(s)
- Shagun Singh
- Department of Oral and Maxillofacial Surgery, 3 Corps Dental Unit, Armed Forces, Dimapur, India
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Knudson SA, Day KM, Kelley P, Padilla P, Collier IX, Henry S, Harshbarger R, Combs P. Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review. Craniomaxillofac Trauma Reconstr 2022; 15:206-218. [PMID: 36081679 PMCID: PMC9446274 DOI: 10.1177/19433875211026432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
Study Design Retrospective case series; systematic review. Objective It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
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Affiliation(s)
- Sean A. Knudson
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
| | - Kristopher M. Day
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Kelley
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Pablo Padilla
- Department of Plastic Surgery,
University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ian X. Collier
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Steven Henry
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Raymond Harshbarger
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
| | - Patrick Combs
- Division of Craniofacial and Pediatric
Plastic Surgery, Dell Children’s Medical Center, The University of Texas at Austin,
Austin, TX, USA
- Department of Plastic Surgery, Dell
Seton Medical Center, The University of Texas at Austin, Austin, TX, USA
- Dell Medical School, The University of
Texas at Austin, Austin, TX, USA
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