Abstract
Background
The retained knife blade is an unusual and spectacular injury. The aim of this study was to review our experience with the management of such injuries.
Methods
A retrospective chart review of patients with retained knife blades treated at Groote Schuur Hospital Trauma Centre from January 1996 to December 2007 was undertaken.
Results
Thirty-three patients with retained knife blades were identified. Site of wound entry was the thorax in 13 patients (40%), the neck and back in 7 patients (21%) each, upper and lower extremities in 4 (12%), and the face and abdomen in 1 patient (3%) each. Thirty patients (91%) were hemodynamically stable on admission; two (6%) presented with wound abscesses, and one patient (3%) with active bleeding required emergency surgery. All 33 blades were extracted after clinical and radiological assessment. Simple withdrawal of the blade was possible in 19 cases (58%) and the likelihood of post-extraction bleeding was only 5%. Thirteen patients (40%) required an open surgical approach through dissection of the entry wound, laparotomy, or thoracotomy. Video-assisted thoracoscopic removal was used in one case. Retained thoracic blades were significantly associated with postoperative sepsis (P = 0.0054). There were no deaths.
Conclusions
All impacted knife injuries require careful clinical and radiological assessment. Simple withdrawal can be performed safely in the emergency room provided potential life-threatening vascular and solid organ injuries have been excluded. There should be a low threshold for investigating and treating patients with retained intrathoracic blades for postoperative sepsis.
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References
Hanoch J, Feigin E, Pikarsky A et al (1996) Stab wound associated with terrorist attacks in Israel. JAMA 276:388–390
Wilson A, McNatt S (2006) A unique zone II neck injury. J Trauma 60:1378
Frangos SG, Ben-Arie E, Bernstein MP et al (2006) Thoracic stab wound with impaled knife. J Trauma 60:1379
Grobbelaar A, Knottenbelt JD (1991) Retained knife blades in stab wounds of the face: is simple withdrawal safe? Injury 22:29–31
Hudson DA (1992) Impacted knife injuries of the face. Br J Plast Surg 45:222–224
Daya NP, Liversage HL (2004) Penetrating stab wound injuries to the face. SADJ 59:55–59
Van Lierop AC, Raynham O, Basson O et al (2008) Retained knife blades in the ear, nose and throat: three cases. J Laryngol Otol 3:1–5
Taylor AG, Peter JC (1997) Patients with retained transcranial knife blades: a high-risk group. J Neurosurg 87:512–515
Thomson BN, Knight SR (2000) Bilateral thoracoabdominal impalement: avoiding pitfalls in the management of impalement injuries. J Trauma 49:1135–1137
Kelly IP, Attwood SE, Quilan W et al (1995) The management of impalement injury. Injury 26:191–193
Madhok BM, Roy DD, Yeluri S (2005) Penetrating arrow injuries in Western India. Injury 36:1045–1050
Fingleton LJ (1987) Arrow wounds to the heart and mediastinum. Br J Surg 74:126–128
Karger B, Sudhues H, Kneubuehl BP et al (1998) Experimental arrow wounds: ballistics and traumatology. J Trauma 45:495–501
Navsaria PH, Vogel RJ, Nicol AJ (2004) Thoracoscopic evacuation of retained posttraumatic haemothorax. Ann Thorac Surg 78:282–286
Navsaria PH, Nicol AJ (2006) Video-assisted thoracoscopic pericardial window for penetrating cardiac trauma. S Afr J Surg 44:18–20
Bar I, Rivkind A, Deeb M et al (1998) Thoracoscopically guided extraction of an embedded knife from the chest. J Trauma 44:222–223
Burach JH, Amilraj EA (2005) Thoracoscopic removal of a knife impaled in the chest. J Thor Cardiovasc Surg 130:1213–1214
Williams CG, Haut ER, Ouyang H et al (2005) Video-assisted thoracic surgery removal of foreign bodies after penetrating chest trauma. J Am Coll Surg 202:848–852
Navsaria P, Maximilien T, Nicol A (2006) Foley catheter balloon tamponade for life-threatening haemorrhage in penetrating neck trauma. World J Surg 30:1265–1268
McCarthy T, Lassota-Korba B, O’Leary T et al (2007) Chest compressions for a patient in cardiac arrest after penetrating trauma with a knife still in situ. Emerg Med J 24:596–597
Lipp M, Mihaljevic V, Jakob H et al (1993) Fibreoptic intubation in the prone position. Anesthesia in a thoracoabdominal knife stab wound. Anaesthetist 42:305–308
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Sobnach, S., Nicol, A., Nathire, H. et al. Management of the Retained Knife Blade. World J Surg 34, 1648–1652 (2010). https://doi.org/10.1007/s00268-010-0514-4
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DOI: https://doi.org/10.1007/s00268-010-0514-4