P ulmonary artery pseudoaneurysms after traumatic injury are a very rare occurrence; only 14 cases have been reported in the literature. Blunt traumatic pulmonary artery pseudoaneurysms constitute a small number of these cases; only three cases have been reported to date. In every reported case of traumatic pulmonary artery pseudoaneurysm since 1920, the pseudoaneurysm was repaired operatively using local resection (aneurysectomy), ligation of vessels, lobectomy, or embolization. 1,2 We report a case of blunt traumatic main pulmonary artery pseudoaneurysm detected on initial computed tomography (CT) that was treated nonoperatively. To our knowledge, this is the first reported pulmonary artery pseudoaneurysm detected immediately on trauma assessment and also the first reported patient with traumatic pulmonary artery pseudoaneurysm treated nonoperatively that survived. CASE REPORTA 57-year-old man who was involved in a head-on motor vehicle collision as the unrestrained passenger presented awake and alert with multiple facial lacerations and unknown loss of consciousness. The patient denied any known drug allergies and took no medications. Medical history was significant for hypertension and diabetes mellitus and there was no surgical history. The patient did admit to regular alcohol and marijuana use but denied any significant family medical history. The primary survey was unremarkable. The airway was patent, Glasgow Coma Scale score was 15, and the patient seemed in no apparent distress. No additional injuries were noted and motor and sensory exams were normal. The usual resuscitation maneuvers were employed.Routine pelvis and chest x-rays were obtained. The chest film revealed minimal widening of the superior mediastinum (measured as 10 cm of 38.5 cm chest width) and tortuosity of the thoracic aorta. The pelvic film was negative. The patient had helical multidetector CT imaging without contrast of the head, face, and c-spine. The head CT was negative for intracranial injury, whereas the CT scan of the face showed minimal medial displacement of the left zygoma. In addition, helical multidetector CT imaging of the chest with intravenous contrast was obtained in addition to the usual abdomen/ pelvis CT with oral and intravenous contrast. The chest CT was added because of widened mediastinum and loss of aortic knob. The chest CT revealed a lobulated contour of the main pulmonary artery with an 18-mm probable pseudoaneurysm along the left superior margin of the main pulmonary artery (Fig. 1). A small amount of mediastinal hematoma was seen although the aorta and great vessels of the arch were intact. There was no evidence of pericardial effusion, pleural effusion, or pneumothorax. The abdomen/pelvis CT scan revealed minimal free fluid in the left upper quadrant inferior to the spleen and in the left paracolic gutter with the absence of identifiable solid organ injury.The patient was then taken for pulmonary angiography, which also revealed a lobulated appearance with a focal contour abnormality along the left anterio...

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Most trauma affecting Hispanic farm workers in Eastern North Carolina is not directly occupational and happens in conjunction with recreational activity, where alcohol is an important risk factor. The human and financial cost resulting from such injuries is of such magnitude that it deserves consideration by everybody who is involved in shaping policies in agriculture, immigration and rural public health.

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Postoperative nausea and vomiting (PONV) is a common complaint after plastic and reconstructive surgery. Transdermal scopolamine is a commonly used agent for prevention of PONV. Anisocoria from transdermal scopolamine use is an adverse effect that has not been reported in the plastic surgery literature. We present a series of 3 craniofacial patients in which ipsilateral mydriasis occurred and spontaneously resolved after removal of the scopolamine patch. Given the various causes and potentially grave implications of unilateral mydriasis, we discourage the use of transdermal scopolamine in craniofacial surgery, and especially in orbital surgery. However, if transdermal scopolamine is decided to be used for PONV prophylaxis, we recommend educating the patient, the operating room staff, and the surgical team regarding this potential adverse effect and to avoid finger-to-eye contamination after patch manipulation.

Mutilating injuries of the hand and congenital hand anomalies can present challenging reconstructive scenarios for salvage and restoration of function. During a 5-year period from 1993 to 1997, the plastic and reconstructive surgical unit of East Carolina University Medical Center was presented with a series of unique reconstructive challenges as a result of complex hand injuries that resulted in unexpected opportunities for the salvage of distal components. These traumatic injuries were unique in that, although devastating to the hand, they left the opportunity for salvage of distal vascularized and sensate components of the hand. Other unique challenges arose as a result of patients who did not want to pursue alternative reconstructive options such as toe-to-hand transfers or pollicization. These cases are presented to emphasize alternative algorithms to standard hand reconstruction in complex scenarios. Three patients presented with distal viable (vascularized and sensate) phalangeal components with proximal complex bony defects, 1 patient presented with a complex thumb defect and declined standard therapy, and 1 patient presented with a congenital thumb anomaly and declined standard therapy. All flaps survived and all hands were saved. These patients illustrate the clinical feasibility of osteocutaneous and free osseous grafting to provide strut stabilization in metacarpal defects and to preserve an opposable post after thumb amputation or thumb anomaly.

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