The use of both operative and non-operative management to treat trauma or injuries related to it is a surgical speciality called trauma surgery. Surgeons are required to undergo and complete residency training in general surgery and fellowship training in trauma or surgical critical care.
A trauma treatment has the major stages – initial resuscitating, stabilizing, evaluating the managing the patient. The trauma surgeon usually operates with a team of nurses, support staff and resident physicians. Limited to military surgeons at one point of time, trauma surgery requires intense training and civilian trauma surgeons were few and far between until a few decades ago.
Trauma usually is a broad classification for multiple injuries that could occur one at a time or many at once. Trauma surgery needs a complete, rapid assessment to treat the most serious injuries first and then a complete the diagnostic tests needed to analyse what other specialists may be required to treat the many injuries. Trauma surgery also includes complete monitoring during the course of recovery.
Eyelid Trauma Surgery
Whenever there is an aggravated assault, unexpected falls, vehicle accidents or other animal related bites and scratches, lacerations might occur in the eyelid. The injuries inflicted might be blunt or penetrating. The actual position of the wound really differentiates how the surgery and post operative care are done for the patient. The intensity of the trauma is also taken into account during emergency treatments
If the lacerations are not on the eyelid or the margin, a simple suture repair and the orbicularis muscle underneath are enough but if the eyelids are involved, the marginal structures should be meticulously rearranged.
Based on the position of the injury, the trauma can be on the inside corner, also known as the medial or the outside corner (lateral). The laceration can also happen in the eyebrow, cheek and other parts of the face surrounding the eyelids. During surgery, extreme care must be taken to ensure that the knots or suture material should not damage the cornea of the eye.
The procedure to properly treat the eyelid trauma must talk about surgery without inflicting any injury on the globe and protecting the cornea, maintaining proper lid dynamics. The risk of infection is high and must be minimised. The foreign bodies, if any, should be removed.
When treated properly, after reconstructing the lid lacerations, the scars are barely visible and the cosmetic result is more than satisfactory. But in case there are any cutaneous scars or lid notching, a revision surgery may be needed.
Canalicular trauma surgery
Canalicular trauma occurs when a sudden physical injury damages the lacrimal drainage system of the eye (tear duct). The lacrimal canaliculi (lacrimal canals / lacrimal ducts) are the small channels in the eyelid that are present inside the medial part of the eyelid. Dog bites are the primary causes of canalicular trauma because of the possibility of this injury occurring near the medial of the eyelid. It requires special attention by a trained surgeon who is experienced in the repair of canalicular lacerations because mistakes can affect vision and movement of eyelids.
Canalicular lacerations may or may not occur with the presence of foreign bodies and might be in and around the periocular area or around the lacrimal passages. The canaliculis, being right in the middle part of the four eyelids, is prone to injuries of varying degree. A canalicular injury might mean a change in the lacrimal drainage system and lead to epiphora where the tears run over the eyelid margin and onto the cheek.
Even if the canaliculis itself is not directly affected, the trauma is still classified as canalicular trauma if it is in the vicinity. Direct injuries might occur due to dog bites or contact with sharp objects and indirect injuries might occur due to things like a fist punch or a vehicle accident or fall that might affect other parts of the face directly and travel to the canalicular area affecting the tear ducts. The canalicular lacerations require a different approach to eliminate the risk of canalicular scarring and tearing due to the injuries.
Bone trauma surgery
A bone trauma (bone fracture) usually occurs due to high force impact or stress on a bone, or due to other medical conditions that weaken the bone (like osteoporosis, bone cancer etc) and called as pathologic fracture. Bone trauma surgery (orthopaedic surgery) concerns the musculoskeletal system and is inclusive of spine diseases, degenerative diseases, injuries, infections, tumours and congenital disorders.
As is common knowledge, the fracture can be isolated in single bones or can have multiple broken bones. Compound fractures usually occur near a joint and the pelvis trauma is the most difficult to treat. Bone trauma surgery can be tricky because poor alignment of bones is a very real, potentially frightening healing problem.
Bone (orthopaedic) trauma covers the complete spectrum of bones, joints and soft tissues (the muscles, tendons and ligaments) of the entire body. It focuses on restoring the anatomic alignment of bones to facilitate the return to the maximum possible function of the injured body part.
Dr. Debraj Shome is a trained trauma surgeon who has tackled even the most severe of canalicular and orthopaedic trauma surgeries with a cosmetic and medical perfection that is hard to match.