Wound ballistics of firearm-related injuries--part 1: missile characteristics and mechanisms of soft tissue wounding

Firearm-related injuries are caused by a wide variety of weapons and projectiles. The kinetic energy of the penetrating projectile defines its ability to disrupt and displace tissue, whereas the actual tissue damage is determined by the mode of energy release during the projectile-tissue interaction and the particular characteristics of the tissues and organs involved. Certain projectile factors, namely shape, construction, and stability, greatly influence the rate of energy transfer to the tissues along the wound track. Two zones of tissue damage can be identified, the permanent cavity created by the passage of the bullet and a potential area of contused tissue surrounding it, produced mainly by temporary cavitation which is a manifestation of effective high-energy transfer to tissue. Due to the complex nature of these injuries, wound assessment and the type and extent of treatment required should be based on an understanding of the various mechanisms contributing to tissue damage.

Management of facial bite wounds

Bite wounds are especially prone to infectious complications, both local and systemic. In bite wounds to the face, such complications can create more difficulties than the initial tissue damage itself for the task of restoring an esthetic appearance. Management should aim to neutralize this potential for infection and provide an infection-free environment for wound healing. Wound cleansing followed by primary closure is the treatment of choice, and the use of prophylactic antibiotics may further decrease the risk of infection. Delay in presentation beyond 24 hours is not necessarily a contraindication to immediate repair, but excessive crushing of the tissues or extensive edema usually dictates a more conservative approach, such as delayed closure.

Short root anomaly associated with Rothmund-Thomson syndrome

A case of short root anomaly in a patient with Rothmund-Thomson syndrome is reported. The syndrome is a rare genodermatosis characterized by poikilodermatous rash starting in infancy, associated with juvenile cataracts, small stature, skeletal abnormalities, dental malformations, and predisposition to skin and bone cancers. In this case, abnormally short roots were detected during radiographic examination, affecting a complete permanent dentition including partially erupted third molars. The report contains a short review of the current literature on Rothmund-Thomson syndrome.

The triple rotation scalp flap revisited: a case of reconstruction of cicatricial pressure alopecia

Rotation flaps constitute a time-honoured method for repair of small-to-moderate scalp defects, in effect even in the era of microsurgical reconstruction. A case of cicatricial pressure alopecia that was successfully repaired using the Bardach modification of the curved tripod flap confirms the value of this flap in scalp reconstruction. The main advantages of this method are the natural appearance of the final result due to preservation of hair orientation, and the uniform distribution of the wound-closure tension over a wide peripheral area of the scalp, although extensive undermining is generally required.

Facial bite wounds: management update

Bite wounds are frequently located on the face; injuries inflicted by dogs are most common, especially in children. Bacteriology of infected dog and cat bite wounds includes Pasteurella multocida, Staphylococcus aureus, viridans streptococci, Capnocytophaga canimorsus, and oral anaerobes. Infected human bites yield a similar spectrum of bacteria except for Pasteurellae and C. canimorsus; instead human bites are frequently complicated by Eikenella corrodens. Antibiotic therapy against these bacteria is indicated both for infected bite wounds and fresh wounds considered at risk for infection. Amoxicillin-clavulanate (and other combinations of extended-spectrum penicillins with beta-lactamase inhibitors) and moxifloxacin offer the best in vitro coverage of the pathogenic flora. Initial wound management consisting in irrigation and debridement is at least equally important with antibiotics for prevention of infection. The need for prophylaxis against systemic infectious complications, particularly tetanus, should also be evaluated. Primary surgical repair is the treatment of choice for most clinically uninfected facial bite wounds, whereas delayed closure should be reserved for certain high risk or already infected wounds. Avulsive injuries with significant tissue loss represent the most difficult cases for definitive management and are also those most likely to require hospitalization.

The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections

A review of the literature on orofacial odontogenic infections indicates that the underlying microflora is typically polymicrobial, predominantly involving strictly anaerobic gram-positive cocci and gram-negative rods, along with facultative and microaerophilic streptococci. Although no single species has been consistently implicated in all of these infections, the pathogenic potential of some of these organisms has been documented by many studies. This potential can be explained by a number of virulence factors demonstrated in anaerobic bacteria, as well as by synergistic interrelationships with other members of the infectious flora. Awareness of the anaerobic component of orofacial odontogenic infections dictates to a large extent the selection of antimicrobial therapy, mainly because of the frequency of beta-lactamase production by anaerobic gram-negative rods.

Stensen's duct obstruction by foreign body and subsequent candidal infection of the parotid gland

A case of chronic inflammation complicated by Candida infection of the parotid gland in a 50-year-old woman is presented. This eventually proved to be caused by Stensen's duct obstruction due to an unusual radiolucent foreign body. The process that led to the proper diagnosis is presented and the importance of surgical exploration of the main duct in cases suggesting distal duct obstruction is stressed.