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| Yi-Kai Yuan,Tong Sun,Yi-Cheng Zhou,Xue-Pei Li,Hang Yu,Jun-Wen Guan.[J].Chin J Traumatol,2020,23(2):84-88. [doi] |
| Rational design of secondary operation for penetrating head injury: A case report |
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| DOI： |
| KeyWord: Rational designSecondary operationPenetrating head injurySkull base fracture |
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| Author Name | Affiliation | | Yi-Kai Yuan | Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041 China | | Tong Sun | Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041 China | | Yi-Cheng Zhou | Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041 China | | Xue-Pei Li | Health Ministry Key Laboratory of Chronobiology, College of Basic Medicine and Forensic Medicine, Sichuan University, Chengdu, 610041 China | | Hang Yu | Health Ministry Key Laboratory of Chronobiology, College of Basic Medicine and Forensic Medicine, Sichuan University, Chengdu, 610041 China | | Jun-Wen Guan | Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041 China |
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| Abstract: |
| Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis
and intraoperative comprehensive exploration are necessary considering the complexity and severity of
the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible
retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-yearold boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head
injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broadspectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical
plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well. |
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