title: Management of the retained knife blade.
abstract: BACKGROUND
  The retained knife blade is an unusual and spectacular injury. The aim of this study was to review our experience with the management of such injuries.
  
  
  METHODS
  A retrospective chart review of patients with retained knife blades treated at Groote Schuur Hospital Trauma Centre from January 1996 to December 2007 was undertaken.
  
  
  RESULTS
  Thirty-three patients with retained knife blades were identified. Site of wound entry was the thorax in 13 patients (40%), the neck and back in 7 patients (21%) each, upper and lower extremities in 4 (12%), and the face and abdomen in 1 patient (3%) each. Thirty patients (91%) were hemodynamically stable on admission; two (6%) presented with wound abscesses, and one patient (3%) with active bleeding required emergency surgery. All 33 blades were extracted after clinical and radiological assessment. Simple withdrawal of the blade was possible in 19 cases (58%) and the likelihood of post-extraction bleeding was only 5%. Thirteen patients (40%) required an open surgical approach through dissection of the entry wound, laparotomy, or thoracotomy. Video-assisted thoracoscopic removal was used in one case. Retained thoracic blades were significantly associated with postoperative sepsis (P = 0.0054). There were no deaths.
  
  
  CONCLUSIONS
  All impacted knife injuries require careful clinical and radiological assessment. Simple withdrawal can be performed safely in the emergency room provided potential life-threatening vascular and solid organ injuries have been excluded. There should be a low threshold for investigating and treating patients with retained intrathoracic blades for postoperative sepsis.
authors.affiliation: Trauma Center, Groote Schuur Hospital, University of Cape Town, Observatory, 7925, Cape Town, South Africa.
authors.forename: Sanju
authors.initials: S
authors.lastname: Sobnach
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicol
authors.forename: Hassed
authors.initials: H
authors.lastname: Nathire
authors.forename: Delawir
authors.initials: D
authors.lastname: Kahn
authors.forename: Pradeep
authors.initials: P
authors.lastname: Navsaria
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D020775:Thoracic Surgery, Video-Assisted; D013909:Thorax; D014951:Wounds, Stab / Q000601:surgery*; D055815:Young Adult