Abstract
Chainsaw accidents are severe injuries, mostly work-related and concerning upper or lower extremities. Few suicidal chainsaw injuries are reported, all of them fatal. We report the case of a 23-year-old man who attempted suicide by sub-decapitation with a chainsaw, its successful (peri-) operative management, and clinical course along with a discussion of the contemporary management and body of evidence of such lesions. Chainsaw injuries are severe traumas. Stepwise surgery with maximal functional reconstruction is safe and optimal clinical outcome can be achieved.
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Aebi M (2010) Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J 19(Suppl 1):S33–S39. https://doi.org/10.1007/s00586-009-1120-8
Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rossler W (2008) Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 86:726–732. https://doi.org/10.2471/blt.07.043489
Archan S, Gumpert R (2010) Penetrating neck trauma causing tracheal rupture, spinal cord injury, and massive pneumocephalus. Am J Emerg Med 28(254):e251–e252. https://doi.org/10.1016/j.ajem.2009.05.004
Bohler J, Gaudernak T (1980) Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma 20:203–205. https://doi.org/10.1097/00005373-198003000-00002
Brodke DS, Anderson PA, Newell DW, Grady MS, Chapman JR (2003) Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech 16:229–235
Brown AF (1995) Chainsaw penetrating neck injury. J Accid Emerg Med 12:134–137. https://doi.org/10.1136/emj.12.2.134
Burgess CA, Dale OT, Almeyda R, Corbridge RJ (2012) An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol 37:44–52. https://doi.org/10.1111/j.1749-4486.2011.02422.x
Firsching R, Rickels E, Mauer UM, Sakowitz OW, Messing-Junger M, Engelhard K, Schwenkreis P, Linn J, Schwerdtfeger K (2017) Guidelines for the treatment of head injury in adults. J Neurol Surg A Cent Eur Neurosurg 78:478–487. https://doi.org/10.1055/s-0037-1599239
Grinsell D, Keating CP (2014) Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Res Int 2014:698256. https://doi.org/10.1155/2014/698256
Hammig B, Jones C (2015) Epidemiology of chain saw related injuries, United States: 2009 through 2013. Adv Emerg Med 2015:4. https://doi.org/10.1155/2015/459697
Kamenova M, Leu S, Mariani L, Schaeren S, Soleman J (2016) Management of incidental dural tear during lumbar spine surgery. To suture or not to suture? World Neurosurg 87:455–462. https://doi.org/10.1016/j.wneu.2015.11.045
Koehler SA, Luckasevic TM, Rozin L, Shakir A, Ladham S, Omalu B, Dominick J, Wecht CH (2004) Death by chainsaw: fatal kickback injuries to the neck. J Forensic Sci 49:345–350
Luszczyk MJ, Blaisdell GY, Wiater BP, Bellabarba C, Chapman JR, Agel JA, Bransford RJ (2014) Traumatic dural tears: what do we know and are they a problem? Spine J 14:49–56. https://doi.org/10.1016/j.spinee.2013.03.049
Menon SK, Onyia CU (2015) A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg 139:248–251. https://doi.org/10.1016/j.clineuro.2015.10.013
Moreschi C, Da Broi U, Cividino S, Gubiani R, Pergher G (2014) Neck injury patterns resulting from the use of petrol and electric chainsaws in suicides. Report on two cases. J Forensic Legal Med 25:14–20. https://doi.org/10.1016/j.jflm.2014.04.004
Schoeneberg C, Schilling M, Keitel J, Kauther MD, Burggraf M, Hussmann B, Lendemans S (2017) TraumaNetwork, Trauma Registry of the DGU(R), Whitebook, S3 Guideline on Treatment of Polytrauma/Severe Injuries - An Approach for Validation by a Retrospective Analysis of 2304 Patients (2002-2011) of a Level 1 Trauma Centre. Zentralbl Chir 142:199–208. https://doi.org/10.1055/s-0033-1360225
Stojanovic I, Milic M, Antovic A, Todorovic S, Jovanovic I (2013) Unusual suicide with a chainsaw. Forensic Sci Int 228:e58–e61. https://doi.org/10.1016/j.forsciint.2013.02.011
Tournel G, Dedouit F, Balgairies A, Houssaye C, De Angeli B, Becart-Robert A, Pety N, Hedouin V, Gosset D (2008) Unusual suicide with a chainsaw. J Forensic Sci 53:1174–1177. https://doi.org/10.1111/j.1556-4029.2008.00795.x
Weaver FA, Yellin AE, Wagner WH, Brooks SH, Weaver AA, Milford MA (1988) The role of arterial reconstruction in penetrating carotid injuries. Arch Surg 123:1106–1111. https://doi.org/10.1001/archsurg.1988.01400330082013
Woodroffe RW, Nourski KV, Helland LC, Walsh B, Noeller J, Kerezoudis P, Hitchon PW (2018) Management of iatrogenic spinal cerebrospinal fluid leaks: a cohort of 124 patients. Clin Neurol Neurosurg 170:61–66. https://doi.org/10.1016/j.clineuro.2018.04.017
Yoshihara H, Yoneoka D (2015) Incidental dural tear in cervical spine surgery: analysis of a nationwide database. J Spinal Disord Tech 28:19–24. https://doi.org/10.1097/BSD.0000000000000071
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All authors confirm that the manuscript and the order of the listed authors have been read and approved by all named authors. P.K., V.M.B., and C.N. performed surgery; P.K., V.M.B., B.M., and C.N. were responsible for clinical care. P.K. wrote the manuscript with input from all authors.
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Krauss, P., Butenschoen, V.M., Meyer, B. et al. Sub-decapitation in suicidal chainsaw injury: report of a rare case and operative management. Acta Neurochir 162, 2537–2540 (2020). https://doi.org/10.1007/s00701-020-04413-7
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DOI: https://doi.org/10.1007/s00701-020-04413-7