Young man was brought to the ED w/ sudden pain in right eye after cutting weeds w/ power trimmer. Opening eye or moving it makes pain worse. Thoughts?

The nail is embedded in the center of the right globe, & there is bleeding. Vital signs & remainder of exam, including peripheral neuro exam, were normal.

The nail traversed the right orbit, narrowly missed the globe, and penetrated the ethmoid and sphenoid bones; its tip rested against the clinoid portion of the contralateral internal carotid artery.

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Oren Gottfried, MD

@OGdukeneurosurg

Nov 18

Wow...46 yo patient whose long hairs were caught in an agricultural thresher machine resulting in Total Scalp Avulsion, but in this case the scalp went missing. This neurosurgical procedure was employed (for vascular supply) w/ spit thickness skin grafts... and it worked.

For small-medium defect primary closure, local flap, free flap, skin graft, & tissue expansionis performed. For near-total or total scalp avulsion, treatment is microsurgical replantation. In this case, that was not an option.

Calvarium Trephination Technique = multiple burr holes are made with drill. Gradually, granulation tissue starts emerging through the burr holes to cover the calvarium. Next, split-thickness skin grafts are applied. This whole procedure takes around 6–8 weeks.

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Oren Gottfried, MD

@OGdukeneurosurg

Nov 18

70-year-old man was stabbed in the left neck by three tines and he was fully conscious and w/o neurological deficits. Paramedics cut down the tines. What structures are you worried about?

Imaging showed a tine penetrated transverse foramen, obstructed left vertebral artery V2 segment, & oozing from VA beside the metal tine. His epiglottis was swollen but there was no air leak. Plan?

So how to manage airway, oozing and obstructed vertebral artery, risk of stroke, and risk of bleeding out? What do you do first?

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Oren Gottfried, MD

@OGdukeneurosurg

Nov 18

I am on this platform too but not going anywhere on twitter as long I can teach and do neurosurgery show and tell. mastodon.world/@ogdukeneurosu…

I am going to try to post some unique and some crossover content over there.

I’m hoping someone resuscitates twitter as I am quite fond of my twitter colleagues and family.

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Oren Gottfried, MD

@OGdukeneurosurg

Nov 17

Warning Sensitive Clinical Image: Total Scalp Avulsion. Young patient was working in a factory when machinery caught her hair removing her entire scalp. Fortunatey, w/ urgent reconstitution of superficial temporal vessels flow the scalp was salvagable & she had a great outcome.

Not my case, Case report reference: news.uams.edu/2017/12/19/med…

*Fortunately … sorry :(

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