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Arrow wounds to the heart and mediastinum
Insights
Arrow injuries to the heart and mediastinum from tribal fighting in Papua New Guinea are treatable. Surgical removal of arrows, even with limited resources, offers good survival rates and recovery for patients with these traumatic injuries.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Global Health
Background:
- Wooden-tipped arrows remain a weapon in tribal conflicts in Papua New Guinea's Highlands.
- Injuries to the heart and mediastinum present a significant challenge in this setting.
Purpose of the Study:
- To describe the clinical presentation, management, and outcomes of patients with arrow injuries to the heart and mediastinum.
- To evaluate the feasibility and effectiveness of surgical intervention in a resource-limited environment.
Main Methods:
- Retrospective review of 13 cases of arrow injury to the heart and mediastinum treated at Mt. Hagen Hospital over a 2-year period.
- Surgical exploration, arrow removal, and repair where indicated were performed in all cases.
Main Results:
- Ten patients presented early (within 3 days), and 3 presented late with mediastinal abscesses.
- Two deaths occurred; morbidity was generally low, with most patients recovering rapidly after surgery (average hospital stay: 20 days).
- Unstable presentations included cardiac tamponade and acute aortic incompetence, but survival figures supported salvage attempts.
Conclusions:
- Surgical management of arrow injuries to the heart and mediastinum is feasible and effective, even in resource-limited settings.
- Prompt surgical intervention can lead to good outcomes and justify salvage efforts for these traumatic injuries.
Abstract:
Wooden tipped arrows are still used in tribal fighting in the Highlands of Papua New Guinea. Thirteen cases of arrow injury to the heart and mediastinum, presenting at Mt. Hagen Hospital in a 2-year period, are described. Ten cases presented early (within 3 days) while the remaining 3 cases presented late and suffered from mediastinal abscesses. Removal of the arrow, after full visualization with repair where possible, was performed in all cases with two deaths and little morbidity. Most of the 13 patients arrived in a stable condition, withstood surgery well and made a rapid recovery (average stay in hospital 20 days). Unstable presentations included 2 cases of mild shock, one with early cardiac tamponade and one case of acute aortic incompetence. Survival figures justify attempted salvage of these patients, even with the limited facilities available.