Particularity And Surgery Countermeasure Of Hand Injury Caused By Corn Harvester

Objective: With the continuous development of social economy and the progress of science and technology increasing day by day, the role of various kinds of agricultural machines in the agricultural production is more and more significant, at the same time, the machine hand injury opportunities also will increase, and the mechanism of injury and particularity is also changing. In the orthopaedic emergency cases, open hand injury occupies a large proportion, that many of these are caused by agricultural machinery. In recent years, with the wide use of corn harvester, corn harvester to hand trauma, more and more, corn harvester speed up corn harvest farmers and lead to a spike in the number of hand trauma, brought a heavy burden to family and society, has caused the attention of the society. The damage mechanism and damage degree, pathogenic bacteria of hand injury caused by corn harvester are obvious different from the traditional hand injury, so the processing and operation method choice has obvious difference. The nature of the damage, the degree of tissue necrosis and infection are very difficult to the clinical repair, are thorny problems for hand surgery doctors. So according to the characteristics of the damage mechanism, the extent of the damage and pollution, the evaluation and analysis the type of pathogenic bacteria of hand injuries caused by corn harvester, we choose corresponding measures and operation method, to provide a certain basis for dealing with hand injury caused by corn harvester.Methods: There are 66 patients of hand injury caused by corn harvester in our hospital from September to October in 2014.Among them there are 50 males and 16 females. Among them the age range is 5 ~ 78 years old, and under the age of 20 of these patients were 2 cases, 9 patients with 20 to 29, 30 ~ 39 patients with 21 cases, 13 patients with 40 ~ 49, 50 ~ 59 patients with 13 cases, 8 patients with aged 60 and above, and the average age of 41.97 years. Among them 60 cases are pure hand trauma, and 5 cases merger lower limb or body compound trauma, and 1 case injures leg. There are 21 cases in injured beyond metacarpophalangeal joints, 1 to 4 cases, 2 to 4 cases, 3 to 3 cases, 4 to the 7 cases, 5 to 3 cases. There are 41 cases injured beyond wrist joints(including wrist joints), and 3 cases of forearm. The time from injury to surgery is 1~12.5 h, and the average time is 7.00 h. The longest hospital stays is 105 days, and the shortest is four days, with an average of 41.30 days. The most operation times is seven times, at least 1 time, with an average of 2.88 times:an operation of 13 cases, 14 cases of secondary operation, three operations of 19 cases, 13 cases of surgery four times, five times surgery in 1 case, 6 surgeries in 4 cases, 7 times surgery in 1 case, 1 case of patients no surgery. One of the patients accepted elective surgery after injury treated, 2 cases of patients turned to our hospital after the surgery in the outer court, one patients refused to surgery since admitted to hospital to observe a few days later, 62 cases of accepted emergency surgery.43 patients experienced one time or more VSD surgery,22 patients experienced flap surgery and 29 patients experienced skin grafting surgery.Among them to discharge training + drug susceptibility of 31 people, according to the results: pure pseudomonas aeruginosa(19 cases), simple ordinary proteus in 2 cases, pseudomonas aeruginosa with ordinary proteus in 1 case, sewer enterobacteriaceae(3 cases), klebsiella pneumoniae pneumonia subspecies in 1 case, meningeal septic golden bacillus in 1 case, 4 cases were no bacterial growth.Results: 58 patients among of all 66 patients experienced one or more surgery and finally discharged from hospital after wound closure, but eight patients refused further surgery due to personal reasons and insisted on discharging from hospital before wound closure. 29 cases of 26 patients with skin graft skin graft survival.1 case of patients with wounds after skin graft appeared a small amount of effusion and bone exposed, wound closured after abdominal skin flap repair.2 patients with skin graft appeared partial necrosis, but they refused further treatment due to personal reasons. 22 cases of flap repair of 18 patients with postoperative flap well covered the wound and blood supply were good, no swelling and obvious exudation appeared. One case of ulnar artery flap with partial necrosis, the wound closured after debridement and skin graft and the skin graft survivaled. 1 case of abdominal skin flap, the wound closured after debridement suture. 1 case of abdominal skin flap with exuded around, the wound closured after taking out dead bone. 1 case of abdomen flap with dark color skin, leakage, poor blood supply, low skin temperature, the residual wound healed after finishing. Three patients got wound healed after amputation. The amputation plane respectively: wrist, forearm middle segment, distal femur. All wounds of these patients were open.Conclusion:1 Hand injury caused by corn harvester most caused by improper operation and violation of operation procedures. This kind of hand injury was complicated, with serious pollution, many times of operations, long hospitalization time, high morbidity, heavy economic burden for patients and huge mental pressure, so hand injury caused by corn harvester should cause the attention of the whole society.2 In emergency processing, we must follow the the processing principle of hand injury to debride. We targeted to take repeated debridement, the VSD coverage and skin flap grafting method to keep the appearance and function of hand utmost.3 Thorough removal of necrotic tissue, full unobstructed drainage, choice of sensitive antibiotics according to germiculture are effective methods to control infection.4 Produce should strength safety device. The corn harvester operators, especially the young people should strength the safety education, and professional training of machine performance, structure and operation procedures.The corn harvester operators should do well the machine testing and maintenance, to ensure the machine in good condition. People should not be too tired when worked. We should preach medical and health care knowledge, to improve the degree of people’s attention to their own safety, to reduce the accidents.