Significant Neurologic Recovery Following a Catastrophic Open Head Injury From a Motorboat Propeller: Case Illustration

Dhall, Sanjay S.; Lin, Franklin J.; Tumialán, Luis M.; Mapstone, Timothy B.

doi:10.1097/ta.0b013e3180312c52

Cited by 6 publications

(11 citation statements)

References 1 publication

(1 reference statement)

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“…Very few surviving cases of open head trauma due to propeller injury have been reported. [1][2][3] In surviving cases, primary skin closure was performed, although the contaminated skull fragment was removed and external decompression was performed. The biggest problems in our case were severe skin defects and exposure of the brain tissue to open air.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Propeller Brain Injury with Large Scalp Defect Treated with Omental Flap

SAGO

SAKAMOTO

MAEDA

et al. 2023

NMC Case Report Journal

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In this study, we report a case of catastrophic propeller brain injury with large scalp defect treated with omental flap reconstruction. A 62-year-old man was accidentally caught in a powered paraglider propeller during maintenance. The rotor blades impacted the left part of his head. On arrival at the hospital, he presented with a Glasgow Coma Scale score of E4V1M4. On some areas on his head, skin was noticeably cut off, and the brain tissue out-slipped through an open skull fracture. Continuous bleeding from the superior sagittal sinus (SSS) and the brain surface was observed during emergency surgery. Massive bleeding from the SSS was controlled using a number of tenting sutures and hemostatic agents. We evacuated the crushed brain tissue and coagulated the severed middle cerebral arteries. Dural plasty using the deep fascia of the thigh was performed. The skin defect was closed using an artificial dermis. The administration of high-dose antibiotics has failed to prevent meningitis. Moreover, the severed skin edges and fasciae were necrotic. Plastic surgeons performed debridement and vacuum-assisted closure therapy to promote wound healing. Follow-up head computed tomography revealed hydrocephalus. Lumbar drainage was performed; however, sinking skin flap syndrome was observed. After removing the lumbar drainage, cerebrospinal fluid leakage occurred. We then performed cranioplasty with a titanium mesh and omental flap on day 31. After the surgery, perfect wound healing and infection control were achieved; however, severe disturbance of consciousness remained. The patient was transferred to a nursing home. Primary hemostasis and infection control are mandatory. An omental flap has been determined to be effective in controlling infection by covering the exposed brain tissue.

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Section: Discussionmentioning

confidence: 99%

Catastrophic Propeller Brain Injury with Large Scalp Defect Treated with Omental Flap

SAGO

SAKAMOTO

MAEDA

et al. 2023

NMC Case Report Journal

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“…Wounds include repeated, deep, and sharp parallel lacerations with potential loss of bone and soft-tissue structures, more frequently involving lower limbs. [ 1 , 4 , 5 , 7 , 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…Propeller injuries from motorboats are a major cause of injury in recreational water activities including deep, multiple, and parallel lacerations that can promote scarring, blood loss, and traumatic or surgical amputations. [ 1 , 4 , 5 , 7 , 9 ]…”

Section: Introductionmentioning

confidence: 99%

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Motorboat propeller-related head injuries: A systematic literature review with a case illustration

Scalia

Silven

Costanzo

et al. 2023

Surgical Neurology International

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Background: Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote scarring, blood loss, traumatic, or surgical amputations. The real incidence of these accidents is still unclear. The authors here present a systematic review of the literature, focusing on head injury, and related recommendations for its evaluation and management, also reporting a case of a female patient injured by a motorboat propeller. Methods: A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of publication date. The following Mesh and free text terms were identified: “motorboat and propeller and injuries” (107 results). Results: A total of 12 papers were included in this systematic review. Only few case reports describing traumatic brain injury (TBI) have been documented. Out of a total of 90 cases analyzed, only five cases with TBI were reported. The authors also reported a case of a 12-year-old female, that during a boat trip, reported a severe polytrauma with concussive head trauma from a penetrating left fronto-temporo-parietal lesion, left mammary gland trauma and fracture of the left hand from falling into the water and impact with a motorboat propeller. She underwent an urgent left fronto-temporo-parietal decompressive craniectomy and then surgery with a multidisciplinary team. At the end of the surgical procedure, the patient was transferred to the pediatric intensive care unit. She was discharged on postoperative day 15. The patient was able to walk without assistance, with mild right hemiparesis and persistence of aphasia nominum. Conclusion: Motorboat propeller injuries can result in extensive damage to soft tissue and bones with severe functional disability, amputations, and high mortality. There are still no recommendations and protocols for the management of motorboat propeller related injuries. Although there are several potential solutions that aim to prevent or ease motorboat-propeller injuries, there are still lack of consistent regulations.

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“…Management protocols should consider size and location of wounds, associated injuries and level of contamination in order to tailor treatment to specific needs. Comprehensive wound management for severe open injuries [7,8] is beyond the scope of this paper, but there are some unique aspects of propeller injuries that should be considered.…”

Section: Injury Evaluation and Initial Managementmentioning

confidence: 99%

Motorboat Propeller Injuries: Report of Thirteen Cases with Review of Mechanism of Injury and Bacterial Considerations

Price¹,

Muszynski²,

Zielinski³

et al. 2014

J Trauma Treat

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patients were admitted to our hospital for management of propeller related injuries. These injuries ranged in severity from superficial lacerations that did not require closure to severe, devastating injuries with limb loss (Table 1). No patients died of propeller injuries after reaching the hospital during the period of this study. Five of the injuries occurred at very low speed (estimated less than 5 mph) including one patient with two amputations. Five occurred at speeds that were estimated to be greater than 10 mph. Three records did not provide enough information to estimate boat speeds. Eleven injuries occurred in fresh water, one in salt water, and one occurred while on land. Fall from a boat prior to propeller strike occurred in seven patients. Four were in the water from skiing or other activities when struck. The sequence of injury could not be determined for one patient (#9), and one propeller injury occurred while on land. Motorboat Propeller IntroductionOutboard motorboat propeller strikes can cause devastating injury, infection, and death. Approximately 10%-15% of propeller injuries are fatal [1,2]. Motorboat propeller injuries present management problems that may be unfamiliar to trauma surgeons because of the mechanism of injury and bacterial contamination from underwater impact. Severity of injury and complex contamination may not be apparent on initial inspection. It has been noted that these injuries are underreported even though laws are in place requiring all boaters to report boating accidents and injuries to local and national authorities [3]. This paper provides a review of all propeller injuries admitted to Orlando Regional Medical Center during a 6 year period. The mechanical aspects of propeller injuries are presented along with a literature review and recommendations for initial evaluation and management. Methods and MaterialsWith approval from our Institutional Review Board and assistance from the health information management office and coding department at Orlando Health Systems all hospitalized patients with ICD-9 and e-codes pertaining to boating injuries were identified between October 2003 and August 2009. A total of 267 patient encounters were identified in this time period. Further review of those 267 charts identified 13 patients with propeller related injuries. Demographic information, injury and treatment data, complications and outcomes were analyzed. AbstractBackground: Motorboat propeller strikes can cause devastating injury due to injury mechanics and complex contamination. The frequency of these injuries has been under-reported. This paper provides a review of propeller injuries admitted to our hospital over a six-year period. Discussion includes injury mechanics, initial management, literature review, accident statistics, and possible prevention measures.

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Significant Neurologic Recovery Following a Catastrophic Open Head Injury From a Motorboat Propeller: Case Illustration

Cited by 6 publications

References 1 publication

Catastrophic Propeller Brain Injury with Large Scalp Defect Treated with Omental Flap

Catastrophic Propeller Brain Injury with Large Scalp Defect Treated with Omental Flap

Motorboat propeller-related head injuries: A systematic literature review with a case illustration

Motorboat Propeller Injuries: Report of Thirteen Cases with Review of Mechanism of Injury and Bacterial Considerations

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