IMPALEMENT OF AN UNUSUAL FOREIGN BODY IN THE LEG – A CASE REPORT

Foreign body penetration is not uncommon and may be glass, shrapnel, needles, etc. and may occur in almost any part of the body. Impalement injury is when a blunt force causes a long object to penetrate a body part resulting in retention of the object in situ. The management following foreign body penetration includes tetanus prophylaxis, parenteral antibiotic cover and removal of the foreign body in the theatre with exploration for neurovascular injury, thorough debridement and repair of any damaged tissue. Here, we report a case of an industrial foreign body that impaled a middle aged male while at work in the left leg which was carefully removed under anaesthesia with no post-operative complications.

Results of hyperbaric oxygen treatment in an at-risk nasal flap following trauma

Hyperbaric oxygen treatment (HBOT) is widely used in otorhinolaryngology for various purposes. A 20-year-old male patient was admitted following a traumatic nasal wound which occurred several hours prior. He had a nasal glass cut from the radix to the supratip area which was primarily closed by non-absorbable suture. The following day, there was a haematoma and necrosis of the skin. The haematoma was drained under local anaesthesia. Blood supply to the nasal skin was severely compromised and only the columellar artery remaining intact, by definition designating this a difficult to heal wound with the risk of overall healing failure. Necrosis of the skin had developed within the first 24 hours. Accordingly, the patient underwent 30 HBOT sessions (two hours at 253.3 kPa) twice daily for four days and daily thereafter. Antibiotic cover and conservative wound management were also used. Complete healing was achieved without the need for additional surgical intervention. We conclude that timely use of HBOT may be a valuable adjunct to conservative wound management in a case of sharp nasal trauma.

Scrotal necrosis and no Fournier’s in sight: a rare case of juvenile gangrenous vasculitis

Juvenile gangrenous vasculitis of the scrotum is a rare entity, of which to our knowledge we describe the first documented case in the UK. It follows a typical disease course, demonstrated by an 18-year-old male who presented with three necrotic scrotal lesions; proceeded by 3 days of fever, pharyngitis and lethargy. Previous cases have been managed successfully with systemic steroids. On this occasion, surgical debridement was made of the necrotic areas under antibiotic cover and complete resolution was achieved with excellent wound healing and no evidence of recurrence. This case report discusses the importance of disease recognition and the merits of surgical management. We also add to the debate as to whether this disease is a variation of pyoderma gangrenosum or a distinct entity itself within the pantheon of scrotal gangrene.

Recurrent lacrimal abscess in infant

Acute dacryocystitis at or shortly after birth is uncommon and its main complication, formation of lacrimal sac abscess, is rare. Uniform and standard treatment protocol for this condition has not been established till date. We report on a 2 month old infant with an abscess of the lacrimal sac. He was treated for similar condition on day 6 of his life by incision and drainage; unfortunately, the condition recurs. This time, he was managed with incision and drainage under systemic antibiotic cover; and an early probing of the nasolacrimal duct (NLD) was done on 7th post-operative day. The patient was followed up for a period of one year without any further recurrence and complication. Pathophysiology of the condition and possible treatment options in children have been discussed.DOI: http://dx.doi.org/10.3126/ajms.v6i2.10458Asian Journal of Medical Sciences Vol.6(2) 2015 121-123