The Treatments Of Hand Injury Caused By Corn Combine

Objectives: In recent years, with the widespread application of corn combine harvester, the hand injury caused by such kind of machine also increases year by year. These machines often coexist multiple mechanisms of injury, and the wound is often seriously polluted by oil and plant debris, the clinical treatment of this type of injury is quite difficult, and the prognosis is generally poor. This study concludes the traumatic characteristics, treatment regulation, prognosis of the hand injury caused by corn combine in the region, and furtherly invests, analysis the pathogen distribution, infection factors. We intend to provide experiences and scientific bases for the clinical treatment of these trauma patients.Methods: From September 2014 to November 2014,the two wards of our department totally treated 48 hand-injury patients caused by corn combines. These patients included 33 males and 15 females, aged 18-78 years, mean 44 years old. These cases were retrospectively invested and analysis. The prognosis of such trauma was classified, in order to summarize the characteristics of this kind of trauma and the treatment. In this study, 26 cases of patients were infected, we statistically analyzed the risk factors of infection. According to collate the results of bacterial culture and drug sensitive test, we analyzed the causes of infection and proposed countermeasures.Results: There was no death case in all patients. They all underwent 1-6 surgeries, an average of three times and the average number of days of hospitalization is 55.3. All of the first operation was debridement, and the fracture, nerve, tendon, vascular injury was repaired in the emergency operation. As for the skin defect, we according to the degree of pollution to choose the operation mode. To the case which was polluted lesser we chose flap coverage, and to the one polluted heavier we cover it by negative pressure suction(VSD). Skin grafting repairs the defect in the second period. 31 cases of all patients appear postoperative infection or necrosis, 17 cases of postoperative infection did not occur or necrosis. The rate of infection and necrosis is 64.6%, the rate of cured patient after first operation is 20.8%, 38 cases need multiple surgical cure. In local area the common pathogenic bacteria of this hang-injury is Pseudomonas aeruginosa. Through the Chi-square test. The logistic regression equation to the risk factor of infection has statistical significance(Table 4).Conclusions: 1. injury is seriously damage to the hand, and it is difficultly to treat and cure the disease, after the injury how to prevent and control the delayed wound infection and tissue necrosis is the difficulty of treatment. 2. Hand-injury caused by corn harvester often have multiple risk factors of infection to co-exist, among the risk factors of infection, visiting time, the degree of injury,postoperative necrosis, operation time, debridement degree have statistical significance. They are the main factors which lead to postoperative infection. Clinicians should improve surgical level of experience, as much as possible to reduce the number and level of predisposing factors. Efforts to prevent the occurrence of postoperative infection 3. Faced with such a trauma physician shouldclosely observe the condition of mental preparation to do multiple operations, while repeatedly to explain the condition of patients and their families to do the long-term psychological treatment and poor prognosis limb prepared to avoid the occurrence of medical malpractice.