J Reconstr Microsurg
DOI: 10.1055/s-0040-1718366
Original Article

Beyond the Tip of the Blade: An Investigation of Upper Extremity Machete Injuries in Honduras

Anna Rose Johnson
1  Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
4  Division of Plastic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
,
Stephanie S. Laínez
2  National Autonomous University of Honduras Faculty of Medical Sciences, Tegucigalpa, Francisco Morazán, Honduras
,
Herman J. Santos
2  National Autonomous University of Honduras Faculty of Medical Sciences, Tegucigalpa, Francisco Morazán, Honduras
,
Austin D. Chen
1  Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Carlos Laínez
3  Section of Plastic Surgery, National Autonomous University of Honduras, Tegucigalpa, Francisco Morazán, Honduras
,
Samuel J. Lin
1  Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Richard L. Agag
4  Division of Plastic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
,
Bernard T. Lee
1  Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
› Author Affiliations

Abstract

Background Machete injuries constitute a major cause of morbidity in Honduras. In this study, we aimed to determine the incidence, initial management, surgical treatment, and follow-up patterns for machete injuries at the national public hospital in Honduras. Microsurgery in Honduras is currently in transition with limitations at multiple levels. This study aims to provide critical information to better prepare visiting surgeons and establishes a blueprint to improve microsurgical reconstruction.

Methods A retrospective chart review was performed to identify patients with machete injuries to the upper extremity (UE) who presented to the Hospital Escuela Universitario (HEU) for treatment from 2015 to 2017. Additional microsurgical data was obtained by personal communication with members of the plastic surgery department at the HEU.

Results Complete data was retrieved for 100 patients who presented to the HEU with a UE machete wound. The cohort was male dominated (93%), employed as farmers (47%), and had a mean age of 32.1 years. Violence was the most common mechanism of injury (p < 0.001). The majority of UE machete injuries involved tendon (70%), nerve (28%), and an open fracture (55%). Of the 76% of patients who were scheduled for a follow-up visit, only 25% attended. Within the last calendar year, one replantation, 10 revascularizations at the wrist and forearm level, three microvascular free tissue transfers, and 175 nerve repairs were performed.

Conclusion Management of UE machete injuries in Honduras is challenging and requires early recognition of possible injuries to multiple anatomical systems. The majority of injuries required operative intervention. Only a small percentage of patients presented for follow up. A program to streamline care starting at injury recognition up to final follow-up is currently unavailable and needs to be developed to optimize microsurgical care.

Note

This work was presented at the Hand Therapy Symposium, 21st Annual Meeting in Philadelphia, PA, on March 3, 2019.




Publication History

Received: 12 April 2020

Accepted: 25 August 2020

Publication Date:
08 October 2020 (online)

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