Long-term results of injury

SCARRING FOLLOWING A DOG BITE 

This girl was bitten on her lip by a dog, needing 20 stitches to suture the wound. Two years later the girl was upset by her appearance and complained that the area felt thick and hard and was numb.

She had tried to massage the area to reduce the swelling and although she felt that she was having some success, she requested referral to a plastic surgeon to discuss the possibility of improving her appearance.

SELF-HARM

This man had fallen into the pattern of self-harm some years previously following a troubled childhood and teenage years. The scars on his arms constantly reminded him of the past and he always felt the need to wear long shirt sleeves.

Self-harm is a rapidly increasing problem in young men; about 39 per cent of those treated in hospital will return with further episodes. The long-term risk of actual suicide is about 5 per cent.

SPLIT EAR LOBE

This girl had caught her earring when she was combing her hair and split her ear lobe, which had never healed.

Reconstruction surgery could be considered after the edges of the tear have healed. Sometimes the repair will leave a hole, with a temporary ring. Use of earrings should be avoided for at least six to eight weeks after surgery.

POST-OPERATIVE KELOID SCAR

This woman complained of the formation of a prominent keloid scar in the centre of the incision for hysterectomy. She said that it was tender, itched and felt as if it was burning. Sometimes it caught and rubbed on her clothes. She had tried rubbing in a topical steroid cream for some weeks but this had failed to improve the situation. Intralesional steroids were tried instead.

Excision of the scar is likely to result in further keloid formation, but sometimes plastic surgeons may have some success if excision is combined with the use of intralesional steroids.

RECURRENT WOUND INFECTION

This patient sustained a cut over the knuckle when her hand went through a pane of glass. At the time the wound was thoroughly explored and sutured. It initially healed satisfactorily but over the ensuing months she returned on several occasions with an infection at the site. An X-ray showed a small fragment of glass at the site. Once it had been removed she had no further trouble.

In cases of glass injury it may be necessary to X-ray the wound to exclude any remaining foreign body.

CHILDHOOD CHEST BURNS

This patient was badly burned at the age of five. She was hospitalised for 10 weeks and on discharge had flexion deformities in the arm and axilla. These later improved by skin grafts.

When the patient reached puberty, her right breast failed to develop normally and, after childbirth, she was unable to breastfeed.

PERFORATION INJURY OF THE EYE

This patient sustained a perforating injury of the right eye during a road traffic accident and is now permanently blind in this eye.

Any such injury requires urgent careful assessment as some high-velocity injuries may be misleading and appear superficial. A careful history of how the incident occurred and whether or not the patient was wearing goggles may help to reach the proper conclusion.

RADIAL NERVE INJURY

This teenager was injured in a road traffic accident and sustained a fracture of the mid-shaft of the humerus with damage to the radial nerve. As a result he was unable to dorsiflex his wrist or extend the fingers or thumb of that hand. For a time he was fitted with a lively splint, which allowed him to flex his fingers but held the wrist and fingers in extension. The nerve was explored but repair was impossible, therefore the surgeon proceeded with tendon transfer operations to restore wrist, finger and thumb extension.

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