Sathyanarayanan Sairandri, Obinero Chioma G, Green Jackson C, Fallah Kasra N, Greives Matthew R, Chen Wendy, Nguyen Phuong D
Division of Plastic and Reconstructive Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Eplasty. 2024 Feb 26;24:e9. eCollection 2024.
Lower extremity (LE) trauma within the pediatric population may be debilitating and have different implications and etiologies than in adults. Specifically, lawnmower injuries can cause catastrophic sequelae to the lower extremities, often requiring complex reconstruction or resulting in amputation. This study aims to present our experience with pediatric LE lawnmower injuries at one of the busiest level 1 trauma centers in the United States.
An IRB-approved retrospective analysis was performed studying pediatric patients (age <18 years) who experienced LE trauma due to a lawnmower injury over a 5-year period (2012-2017). Patient demographics, perioperative data, and types of reconstruction were reviewed. Univariate analysis of the data was performed to examine trends in exposure and management of pediatric LE lawnmower injuries.
Twenty-three patients were identified with pediatric LE lawnmower injuries, of whom 82.6% were male. The patients had a median age of 6 years and a median Injury Severity Score (ISS) of 4. Over one-third (34.8%) of this cohort required immediate amputation. Additionally, 26.1% and 8.7% required local and free flap reconstruction, respectively. In comparison, only 3.6% and 2.3% of all traumatic pediatric LE injuries from the same time frame required local and free flaps, respectively.
Lawnmower injuries to the LE can be devastating, causing long-term physical, emotional, and psychosocial consequences for pediatric patients and their families. The data in this study suggest that pediatric LE injuries from lawnmowers more often require complex reconstruction than other traumatic LE injuries. Rapid and effective decision-making by experienced surgeons is necessary to optimize the potential for limb salvage in pediatric LE lawnmower injuries. An algorithm of recommendations on when to transfer these types of injuries to more experienced tertiary centers is provided. Additional resources should be dedicated toward improving public awareness and industrial safety features to help prevent lawnmower injuries in pediatric patients.
儿科人群的下肢创伤可能会使人衰弱，其影响和病因与成人不同。具体而言，割草机损伤可导致下肢灾难性后果，通常需要进行复杂的重建手术或导致截肢。本研究旨在介绍我们在美国最繁忙的一级创伤中心之一处理儿科下肢割草机损伤的经验。
进行了一项经机构审查委员会批准的回顾性分析，研究在5年期间（2012 - 2017年）因割草机损伤而遭受下肢创伤的儿科患者（年龄<18岁）。回顾了患者的人口统计学数据、围手术期数据和重建类型。对数据进行单因素分析，以研究儿科下肢割草机损伤的暴露情况和处理趋势。
确定有23例儿科下肢割草机损伤患者，其中82.6%为男性。患者的中位年龄为6岁，中位损伤严重程度评分（ISS）为4。该队列中超过三分之一（34.8%）的患者需要立即截肢。此外，分别有26.1%和8.7%的患者需要局部和游离皮瓣重建。相比之下，同一时期所有创伤性儿科下肢损伤中，分别只有3.6%和2.3%的患者需要局部和游离皮瓣。
下肢割草机损伤可能是毁灭性的，会给儿科患者及其家庭带来长期的身体、情感和心理社会后果。本研究中的数据表明，与其他创伤性下肢损伤相比，儿科下肢割草机损伤更常需要复杂的重建手术。经验丰富的外科医生迅速而有效的决策对于优化儿科下肢割草机损伤肢体挽救的可能性至关重要。提供了关于何时将这类损伤转诊至更有经验的三级中心的建议算法。应投入更多资源来提高公众意识和改善工业安全特性，以帮助预防儿科患者的割草机损伤。
