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Sherkhane R, Singh S, K T A, Kumar A, Sharma A, Gupta SJ. An integrative approach for management of post-traumatic dorsal foot wounds - A case report. J Ayurveda Integr Med 2024; 15:100905. [PMID: 38574517 PMCID: PMC11002676 DOI: 10.1016/j.jaim.2024.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 04/06/2024] Open
Abstract
Crush injuries to the foot have become increasingly prevalent in contemporary settings, primarily arising from incidents such as the impact of large objects falling onto the foot or involvement in traffic accidents. The complexity of treating these injuries is compounded by the intricate anatomy of the foot. In specific scenarios, the implementation of an integrated management approach could prove advantageous. In this report, we depict the case of a 23-year-old male who visited the Shalya OPD with a wound on his left foot caused by trauma. The wound covered the medial portion of the foot, involving the dorsal area, and measured roughly 20 cm by 9 cm and was unable to walk. We successfully managed the case by adopting an integrative approach. The Ayurvedic treatment included Panchavalkala kashaya for wound irrigation, as well as oral administration of Amalaki rasayana, Triphala guggulu, Shatavari churna and Ashwagandha churna. Jatyadi taila was topically applied. For the first seven days, in addition to these ayurvedic medications, we also employed analgesics and antibiotics to treat infection and pain. To accomplish early closure, we employed a split-thickness skin graft after sufficient granulation tissue had appeared. The wound was completely healed within three months and the patient was able to walk freely without any support. The combined approach yielded a promising result in this case.
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Affiliation(s)
- Rahul Sherkhane
- Dept. of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University, Varanasi, 221005, India.
| | - Shruti Singh
- Dept. of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University, Varanasi, 221005, India
| | - Aadithyaraj K T
- Dept. of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University, Varanasi, 221005, India
| | - Anil Kumar
- Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Sharma
- S S Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shiv Ji Gupta
- Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Schaefer E, Lawson J, Ibrahim T, Yohe G, Zhang G, Giladi AM. Antibiotic Prophylaxis in the Management of Distal Fingertip Amputation and Crush Injury. J Hand Surg Glob Online 2023; 5:763-767. [PMID: 38106926 PMCID: PMC10721494 DOI: 10.1016/j.jhsg.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We sought to investigate the role of prophylactic antibiotics for distal fingertip crush injury or transphalangeal amputation treated outside of an operating room and better understand the factors that contribute to antibiotic-prescribing decisions. We hypothesized that prophylactic antibiotics do not meaningfully reduce the incidence of infection and that antibiotics are prescribed in a predictable way. Methods This is a retrospective review of all patients treated in a MedStar-affiliated emergency department or urgent care for nonsurgical distal fingertip trauma in 2019. Patient demographics, comorbidities, injury characteristics, interventions, and follow-up details were recorded. Exclusion criteria included signs of infection at the time of presentation, minor injuries not requiring intervention, bite wounds, one-time intravenous antibiotic administration without oral course, and surgical intervention. Outcomes included infection and interventions at follow-up. Chi-square analysis was performed, comparing antibiotic and no-antibiotic groups. A stepwise binomial regression was used to evaluate for variables predictive of antibiotic prescription. Results We identified eight infections in 323 patients included in the study (2.5% incidence of infection). There was no statistically significant difference in the incidence of infection between patients treated with antibiotics (2.7%) and those who did not receive antibiotics (2.2%). However, due to the low incidence of infections, we were likely underpowered for this analysis. We also created a model to predict antibiotic prescribing, which achieved an area under the receiver operating characteristic curve of 0.86 (P < .0001) based on age, bleeding disorders, depressive disorders, open wound status, amputation, fractures, and encounter type. Conclusions The low incidence of infection (2.5%) and lack of a meaningful difference between the groups call into question prophylactic antibiotic prescribing after these distal fingertip injuries. Our model does predict provider prescribing habits, identifying areas for potential practice pattern change. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Eliana Schaefer
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
- Georgetown University School of Medicine, Washington, DC
| | - Jonathan Lawson
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
- Georgetown University School of Medicine, Washington, DC
| | - Tamara Ibrahim
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
- Georgetown University School of Medicine, Washington, DC
| | - Gabriel Yohe
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
- MedStar Health Research Institute, Hyattsville, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
- MedStar Health Research Institute, Hyattsville, MD
| | - Aviram M. Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
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Choi JH, Choi SY, Hwang JH, Kim KS, Lee SY. Finger compartment syndrome due to a high-pressure washer injury: A case report. World J Clin Cases 2023; 11:3017-3021. [PMID: 37215431 PMCID: PMC10198083 DOI: 10.12998/wjcc.v11.i13.3017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/03/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although the finger compartment syndrome is not common, it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers, causing necrosis of the fingertips. Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment. Herein, we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.
CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station. The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger. The fingertip was pale, numb, and characterized by severe swelling and a limited range of motion. Finger radiography showed that there was no fracture in the finger. Digital decompression was performed through finger fasciotomy by bilateral midline incision. On the second day after surgery, the color of the fingertip returned to pink, swelling was resolved, and the range of motion returned to normal. The sensation of the fingertip was completely restored, and the capillary refill test and pinprick test were positive.
CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station. To avoid finger necrosis, rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.
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Affiliation(s)
- Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Seung Yeon Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Hospital Chonnam National University Medical School, Gwangju 61469, South Korea
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Sharma A, McCloskey B, Hui DS, Rambia A, Zumla A, Traore T, Shafi S, El-Kafrawy SA, Azhar EI, Zumla A, Rodriguez-Morales AJ. Global mass gathering events and deaths due to crowd surge, stampedes, crush and physical injuries - Lessons from the Seoul Halloween and other disasters. Travel Med Infect Dis 2022; 52:102524. [PMID: 36516965 DOI: 10.1016/j.tmaid.2022.102524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
| | - Brian McCloskey
- Global Health Program, Chatham House, Royal Institute of International Affairs, London, UK
| | - David S Hui
- Department of Medicine & Therapeutics and Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Adam Zumla
- Accident and Emergency Department, Royal Albert Edward Infirmary, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Tieble Traore
- Emergency Preparedness and Response Programme, WHO Regional Office for Africa, Dakar Hub, Dakar, Senegal
| | - Shuja Shafi
- Mass Gatherings and Global Health Network, London, UK
| | - Sherif A El-Kafrawy
- Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, and Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, and Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London; and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Américas - Institución Universitaria Vision de Las Americas, Pereira, Risaralda, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, P.O. Box 36, Lebanon.
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Abstract
Pediatric fingertip injuries are common and peak at 2 years of age. These injuries most frequently result from a crush mechanism and half sustain an associated fracture. The presence of a physis results in unique injury patterns and management considerations in the growing child. Due to a substantial healing potential in children, an initial conservative approach to management for many soft tissue and nail bed injuries is recommended. This article reviews the evidence and approach for treating pediatric fingertip injuries and amputations.
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Affiliation(s)
- Scott N Loewenstein
- Division of Plastic Surgery, Integrated Plastic Surgery Residency Program, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Suite 232, Indianapolis, IN 46202, USA
| | - Joshua M Adkinson
- Division of Plastic Surgery, Sidney and Lois S. Eskenazi Hospital, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Suite 232, Indianapolis, IN 46202, USA.
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Arango-Granados MC, Cruz Mendoza DF, Salcedo Cadavid AE, García Marín AF. Amputation in crush syndrome: A case report. Int J Surg Case Rep 2020; 72:346-350. [PMID: 32563818 PMCID: PMC7306514 DOI: 10.1016/j.ijscr.2020.05.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022] Open
Abstract
Crush syndrome (CS) produces severe electrolyte disorders, circulatory and multiple organ failure due to severe rhabdomyolysis and reperfusion injuries. To date, the main stem of management is aggressive fluid resuscitation. Fasciotomy for the treatment of compartment syndromes due to crush injuries is still controversial, and it is still unknown if early amputation has patient-centered benefits. This case suggests a potential benefit of amputation in patients with CS and progressive deterioration. It also invites to think if this is a decision to consider early in the course of the disease. The presence of risk factors for poor prognosis and the natural course of the disease can favor amputation despite the apparent viability of the limb and the morbidity of losing of an extremity.
Introduction Crush syndrome (CS) is a condition with a high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. There is controversy about the role of fasciotomy in the treatment of compartment syndromes due to crush injuries and it is still unknown if early amputation has patient-centered benefits. Case presentation This is a 29-year-old patient whose lower body was trapped for 50 h under a 40-meter landslide. Upon admission the left thigh was edematous and painful. Laboratories revealed a creatinine of 1.58 mg/dL, hyperkalemia, metabolic acidosis, hyperlactatemia and creatinine phosphokinase (CPK) of 88,700 U/L, suggesting CS. Despite fluid and bicarbonate infusion his renal function worsened, CPK rose and left thigh became more tense, so a fasciotomy was performed. He developed a distributive shock refractory to vasopressors, steroids and methylene blue so amputation was proposed. Two hours after amputation the vasopressor support was nearly withdrawn. Discussion This case suggests a potential benefit of amputation in patients with CS and progressive deterioration despite aggressive resuscitation. It also invites to think if this is a decision that should be considered before the establishment or in the initial stages of the syndrome, even if the viability of the extremity is still questionable. Conclusion The presence of risk factors for poor prognosis can favor amputation despite the apparent viability of the limb and the morbidity of losing an extremity.
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Affiliation(s)
- María Camila Arango-Granados
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Diego Fernando Cruz Mendoza
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Alexander Ernesto Salcedo Cadavid
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
| | - Alberto Federico García Marín
- Fundación Valle del Lili, Cra. 98 ## 18-49, Cali, Valle del Cauca, Colombia; Universidad Icesi, Cl. 18 #122-135, Facultad de Medicina, Cali, Valle del Cauca, Colombia.
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Abstract
Crush injuries of the hand are a rare but devastating phenomenon, with historically poor outcomes. A compressive force, usually caused by a high-energy mechanism such as a motor vehicle or industrial accident, crushes and transiently increases the pressures within the hand. This force acts on the incompressible blood in the vasculature and leads to a dramatic rise in tissue pressures and damage to multiple tissue types, including bones, blood vessels, nerves, and soft tissues. A wide zone of injury results from a delayed inflammatory reaction involving the zone bordering the crushed cells, which may initially belie the severity of the injury. As such, these injuries go on to produce tremendous inflammation and swelling, potentially followed by compartment syndrome or other vascular damage, infection, neurological injury, and tissue necrosis. Crush injuries with minimal skin disruptions can be particularly challenging to accurately diagnose and manage. This paper provides a review of the initial evaluation of hand crush injuries as well as short- and long-term management strategies.
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Affiliation(s)
- Avi D Goodman
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
| | - Christopher J Got
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Arnold-Peter C Weiss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Arjun RHH, Goni V, Guled U, Patel S, John R, Behera P. Sagittal cut injury of the foot at workplace - A rare injury pattern and its management. Foot (Edinb) 2016; 27:16-8. [PMID: 26896671 DOI: 10.1016/j.foot.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/09/2015] [Accepted: 09/22/2015] [Indexed: 02/04/2023]
Abstract
Extremity injuries to employees in an industrial setting are not an uncommon event in today's mechanised workspace. Cut injuries of the foot during handling of machines are common in the workplace and the management of such injuries depends upon various factors at the time of presentation. This case report describes a rare foot injury which has not previously been reported in the literature and describes its subsequent successful management.
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Affiliation(s)
- R H H Arjun
- Department of Orthopedics, PGIMER, Chandigarh, India.
| | - Vijay Goni
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Uday Guled
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Sandeep Patel
- Department of Orthopedics, ESI Medical College and Hospital, Bangalore, India
| | - Rakesh John
- Department of Orthopedics, PGIMER, Chandigarh, India
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Karimkhani C, Amir M, Dellavalle RP, Ipaktchi K. Current concepts for oil decontamination of crush injuries: a review. Patient Saf Surg 2014; 8:22. [PMID: 24855490 PMCID: PMC4030045 DOI: 10.1186/1754-9493-8-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022] Open
Abstract
This anecdotal, non-systematic review serves to explore the principles and methods of effective oil decontamination from cutaneous wounds, particularly crush injuries. The current expansion of the petroleum industry is necessary to meet increasing world demands for oil. Most stages of oil refining and applications involve significant injury risks, particularly for crush injuries that become contaminated with petroleum compounds. A literature review regarding a standard of care for effective cutaneous oil decontamination is lacking. Based on case reports, animal models, and in vitro studies identified in our expert opinion review, standard water and soap cleansing may not be an appropriate approach. Instead, the principle of ‘like dissolves like’ guides the use of lipophilic, petroleum-derived solvents to attract and subsequently dissolve the petroleum contaminant from the skin injury. Limitations include paucity of and dated literature sources regarding the topic as well as no models specifically addressing crush injuries. Our literature review found that oil decontamination of cutaneous injuries may be best accomplished with oil-based cleansers. Certainly, this topic has significant importance for the potentially carcinogenic petroleum compounds that pervade virtually every aspect of modern human life.
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Affiliation(s)
- Chante Karimkhani
- Columbia University College of Physicians and Surgeons, 630 W. 168th Street, New York, NY 10032, USA
| | - Mahsa Amir
- Department of Dermatology, University of Colorado School of Medicine, Anschutz Campus, Aurora, CO 80045, USA
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Anschutz Campus, Aurora, CO 80045, USA ; Dermatology Service, Department of Veterans Affairs Medical Center, 1055 Clermont Street, Box 165, Denver, CO, USA ; Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Kyros Ipaktchi
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA
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