某年1月7日10：00许，某市垃圾填埋场内发现一具裸体女尸。经查，死者系廖某，25岁。该垃圾填埋场负责收集全市的生活垃圾，环卫工人一般于凌晨对街边垃圾桶进行清运。.

This case report explores the management of a traumatic hemipelvectomy-a rare and devastating injury characterized by a high mortality rate. The patient, a 12-year-old male, suffered right lower extremity amputation and right hemipelvectomy due to a deglov-ing injury from a non-vehicle-related accident at another institution. Initially, an urgent reconstruction of the right pelvic region and suprapubic tissue defects was performed using a posterior-based fasciocutaneous flap. Following this, the patient was transferred to the pediatric intensive care unit at our hospital with a suspected diagnosis of necrotizing fasciitis. Treatment included broad spectrum antibiotics and multiple debridements to avert the onset of sepsis. Eventually, reconstruction of a 60 x 25 cm defect covering the lower back, abdomen, gluteal, and pubic regions was achieved through serial split-thickness skin grafts and a pedicled anterolateral thigh flap. The patient made a remarkable recovery, regained mobility with the aid of a walker, and was discharged in good health 22 weeks after the initial accident. This case report underscores the importance of serial debridements in preventing sepsis, the use of negative pres-sure vacuum dressing changes, the initiation of broad-spectrum antibiotics based on culture results during debridements, and prompt closure of the defect to ensure survival after traumatic hemipelvectomy. Familiarization with the principles discussed here is crucial to minimizing mortality rates and optimizing outcomes for this rare injury.

Crush injuries to the foot have become increasingly prevalent in contemporary settings, primarily arising from incidents such as the impact of large objects falling onto the foot or involvement in traffic accidents. The complexity of treating these injuries is compounded by the intricate anatomy of the foot. In specific scenarios, the implementation of an integrated management approach could prove advantageous. In this report, we depict the case of a 23-year-old male who visited the Shalya OPD with a wound on his left foot caused by trauma. The wound covered the medial portion of the foot, involving the dorsal area, and measured roughly 20 cm by 9 cm and was unable to walk. We successfully managed the case by adopting an integrative approach. The Ayurvedic treatment included Panchavalkala kashaya for wound irrigation, as well as oral administration of Amalaki rasayana, Triphala guggulu, Shatavari churna and Ashwagandha churna. Jatyadi taila was topically applied. For the first seven days, in addition to these ayurvedic medications, we also employed analgesics and antibiotics to treat infection and pain. To accomplish early closure, we employed a split-thickness skin graft after sufficient granulation tissue had appeared. The wound was completely healed within three months and the patient was able to walk freely without any support. The combined approach yielded a promising result in this case.

This case series aims to provide a comprehensive description of the utilization of doppler ultrasonography (USG) and computerized tomography angiography (CTA) in evaluating patients with earthquake-induced crush injuries in the emergency department (ED).
This retrospective case series was conducted on 11 patients who presented with crush injuries following a seismic event. These patients underwent initial assessment using doppler USG, with CTA performed when deemed necessary. Clinical outcomes and diagnostic findings were systematically reviewed.
A cohort of 11 earthquake-related crush injury patients (six females, five males; age 3-59 years), predominantly with lower extremity injuries, with entrapped durations that ranged from 12 to 128 hours. Transport centers received patients from both affected regions and nearby provinces. Initial X-rays identified fractures in two cases. Doppler USG and subsequent CTA were employed for vascular evaluation, with CTA confirming doppler USG findings. Of the 11 patients, five exhibited abnormal doppler USG findings. Four patients required dialysis and four underwent amputation surgery. Fasciotomy and debridement procedures were performed in five and seven patients, respectively. Three patients received hyperbaric oxygen therapy (HBOT).
Doppler USG emerged as a dependable tool for assessing vascular injuries in earthquake-related crush injuries, offering an effective alternative to CTA without the associated contrast agent risks. These findings underscore the need for further research to establish definitive imaging guidelines in these challenging clinical scenarios.

A serious kind of fractured foot ailment is a foot crush injury. Foot injury commonly happens in accidents involving transportation or the workplace, such as automobile accidents, big objects falling on the foot, or heavy machinery running over the foot. Foot crush injuries are more severe than regular foot fractures. These wounds are usually very serious, involving many fractures and soft tissue injuries. The main symptoms include pain, severe muscle and tissue damage, and extreme swelling. Because of this, treating a foot crush injury can be quite challenging and frequently requires the collaboration of physical therapists, orthopedic surgeons, and podiatrists. Physiotherapy is important for reducing pain, increasing range of motion, strengthening muscles, and improving leg function. It also decreases the chance of contractures, deformities, and stiffness following crush injuries. In this report, we present the case of a 58-year-old male with a lacerated wound over his left foot with chief complaints of severe pain. Patient-tailored physiotherapy rehabilitation, including active movements, passive movements, isometric exercises, and a strengthening regimen consisting of numerous repetitions and progressive complexity, was given. At the end of four weeks, the patient had improved strength and quality of life.

BACKGROUND: Complicated pressure injury in paraplegic patients is common and difficult to manage. Previous case studies have documented short-term management; however, little is known regarding suitable approaches to long-term clearing of extensive pressure injury in the sacrococcygeal area under denervation.
METHODS: A 53-year-old man was bedridden for 1.5 years owing to cervical vertebral fracture-dislocation (C5-C6), resulting in extensive sacrococcygeal pressure injury.
METHODS: On admission, he presented with the injury complicated by infection (stage IV necrosis), and his vital signs were unstable.
METHODS: The infection was treated with a range of antibiotics, including clindamycin phosphate, metronidazole, cefoperazone sodium, and sulbactam sodium. Debridement of the pressure injury was performed, helping remove the necrotic tissue and stimulate tissue regeneration.
RESULTS: The patient was discharged after 88 days of hospitalization. The extent of the pressure injury at discharge was reduced compared with that at admission. At 4-month follow-up, the injury was nearly healed, with no signs of any further complications.
CONCLUSIONS: This case study suggests that wound debridement is a cost-effective and clinically efficacious approach to long-term complicated pressure injury management.

BACKGROUND: Pressure ulcers are a common health issue, particularly among elderly and bedridden patients who are vulnerable to pressure injuries in the sacral region. Currently, free flap and local flap surgeries are the gold standard procedures for the reconstruction of such injuries. However, the recurrence rate of flap surgery appears to be high. In this context, we presented a case involving a sacral pressure ulcer reconstructed with dermal grafting.
METHODS: A 59-year-old male with a medical history of hepatitis C, brain hemorrhage, hydrocephalus, and multiple fractures presented with a sacral ulcer. Owing to the patient\'s history of recurrent pressure injuries and the challenges associated with postoperative wound care, the patient and his family were hesitant to proceed with flap surgery.
METHODS: The patient was diagnosed with a stage IV pressure ulcer measuring 4 cm × 4 cm in size in the sacral region, according to the National Pressure Ulcer Advisory Panel staging system.
METHODS: Before surgery, the patient received standard wound care with dressing for 4 months, along with short-term oral antibiotics due to a positive wound culture for Pseudomonas aeruginosa. During the surgery, a dermal graft with a size of 35 cm2 and a thickness of 0.014 inches was harvested from the patient\'s left thigh. The graft was then secured to the wound bed.
RESULTS: Although the dermal graft failed with sloughing after 1 week, the wound bed showed improvement with granulation. After 1.5 months, the wound area had decreased to half of its original size, and the wound eventually healed after 3.5 months.
CONCLUSIONS: Dermal grafts have a niche in reconstructing pressure injury wounds in the sacral region, because of the relative ease of wound care and additional benefits even in cases where the graft fails.

METHODS: We present a case of an anteroposterior compression (APC) type pelvic ring injury that occurred after chiropractic manipulation in a patient with a history of quadriplegia. Emergent surgical stabilization was undertaken, and he had an excellent outcome with no complications at 3.5-year follow-up.
CONCLUSIONS: APC type pelvic ring injuries usually occur to high-energy mechanisms. We describe a case of a patient with quadriplegia and osteopenia that suffered a pelvic ring injury because of a unique mechanism. Practitioners performing pelvic manipulation should be aware of this type of injury in at-risk patients.

BACKGROUND: Although the finger compartment syndrome is not common, it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers, causing necrosis of the fingertips. Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment. Herein, we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.
METHODS: A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station. The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger. The fingertip was pale, numb, and characterized by severe swelling and a limited range of motion. Finger radiography showed that there was no fracture in the finger. Digital decompression was performed through finger fasciotomy by bilateral midline incision. On the second day after surgery, the color of the fingertip returned to pink, swelling was resolved, and the range of motion returned to normal. The sensation of the fingertip was completely restored, and the capillary refill test and pinprick test were positive.
CONCLUSIONS: The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station. To avoid finger necrosis, rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.

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