Purpose: Self-inflicted facial gunshots (SIGSWs) typically result in a spectrum of severe injuries to facial structures, including the orbit and globe. Roughly three-quarters of those who arrive to the hospital will survive their injuries, and recidivism is typically low. Therefore, effective management is paramount to preserve vision, and long-term quality of life. The objective of this study is to characterize the common injuries to the orbit, globe, and periocular structures following SIGSWs, their management, and their eventual visual and reconstructive outcomes. Methods: Retrospective review of trauma registry records at a Level 1 trauma center for patients who presented alive following SIGSWs involving the globe and/or orbit from 2007 to 2016. Results: Of the 47 patients who presented with SIGSWs to the orbit, 33 (70%) were discharged alive from the hospital. Management strategies for these patients fell into 3 groups, based on the involved structures: i) Open globe injuries (Type I: n = 12, 34%) ii) Orbital fractures with preserved globe and optic nerve (Type II: n = 15, 43%), and iii) Optic nerve injuries with preserved globe (Type III: n = 8, 23%). Compared with Type II and III injuries, patients who had Type I injuries were more likely to die prior to hospital discharge (46% vs. 20% vs. 12%, p = 0.04), undergo ophthalmologic intervention (73% vs. 6% vs. 11%, p = 0.01), and more surgery (6 vs. 3 vs. 0.5 mean surgeries, p < 0.001). Type II injuries most frequently underwent debridement and reconstruction of the bony orbit. Type III and Type I injuries were associated with worse initial and final visual acuity, with the majority (100% and 75%, respectively) having No Light Perception (NLP) on initial exam, and no visual recovery during the follow-up period (median follow up= 25 months). Conclusions: Management and visual outcomes of orbital injuries from SIGSWs is determined by whether the globe and optic nerve are preserved. Open globe injury by itself is associated with higher mortality and significant permanent vision loss.
INTRODUCTION:We introduce a validated model for identifying patients at increased risk for morbidity after breast surgery. With increased mastectomy rates across all ages 1 , it is crucial to devise a validated model to reliably predict postoperative morbidity. This allows better identification of high-risk patients, provides evidence-based strategy for preoperative safety optimization, and contributes to hospital cost reduction. We reviewed a large prospective risk-adjusted registry to build a risk assessment tool that predicts morbidity after mastectomy.
Burn survivors are at risk for dissatisfaction with body image, relationships, and sexuality due to disfiguring changes secondary to the injury. This review compares available global data on BSHS-B psychosocial scores. Twenty-four studies were included in the final analysis encompassing 14 countries; significant differences were found in scores across all BSHS-B psychological sub-sections of affect, body image, interpersonal relationships, and sexuality. On the whole, psychological well-being after burn injury was lower in Asian and South Asian countries compared to Europe or the United States. This study provides information for providers in burn centers caring for patients from a variety of cultural contexts and begins to steer initiatives to remedy psychological inequities in global burn care.
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