Branch Leslie G, Crantford John C, Thompson James T, Tannan Shruti C
From the Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC.
Ann Plast Surg. 2017 Nov;79(5):490-494. doi: 10.1097/SAP.0000000000001146.
From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower-related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature.
A retrospective review was performed at a level 1 trauma center over a 10-year period (2005-2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included.
Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings.
This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these children. Increased public awareness is insufficient to decrease the incidence of these injuries. These products should have additional warning labels and meet updated changes to the design of lawn mowers to prevent these mutilating injuries successfully.
2004年至2013年期间，20岁以下儿童发生了9341起割草机伤害事件。尽管实施了各种不同的预防策略，但自1990年以来，儿童割草机伤害的发生率并未下降。在本报告中，作者回顾了一家三级医疗转诊中心治疗的与儿童割草机相关的下肢损伤结果，并对整体文献进行了综述。
在一家一级创伤中心进行了为期10年（2005 - 2015年）的回顾性研究。纳入了因下肢割草机伤害而到急诊室就诊的18岁以下患者。
在此期间的27例下肢割草机伤害患者中，受伤时的平均年龄为5.5岁，损伤严重程度评分为7.2。大多数（85%）患者为男孩，造成伤害的主要割草机类型是乘骑式割草机（96%）。78%的受伤患者是旁观者,11%是乘客，11%是操作人员。平均住院时间为12.2天,平均重建时间为7.9天。每位患者的平均手术次数为4.1次。15例（56%）发生截肢，最常见的截肢部位是跖趾关节远端（67%）。重建手术范围从直接缝合（41%）到游离组织移植（7%）。主要并发症包括感染（7%）、伤口裂开（11%）和伤口愈合延迟（15%）。平均随访时间为23.6个月，100%的患者受伤后能够行走。受伤最严重、截肢数量最多且需要进行整体手术的患者亚组为2至5岁的儿童。对文献的综述也显示出一致的结果。
本研究表明割草机对儿童群体，尤其是2至5岁的儿童存在危险并会导致发病。在护理这些儿童时使用了所谓重建阶梯的每一级。公众意识的提高不足以降低这些伤害事件的发生率。这些产品应增加警示标签，并符合割草机设计的更新变化，以成功预防这些致残性伤害。
