II. Epidemiology

  1. Injuries often occur in children
    1. Age under 5 years
      1. Bystander (60%)
      2. Riding mower passenger (15%)
      3. Operator of mower (25%)
    2. Age 8 to 14 years
      1. Operator of mower
  2. Lawn Mower Injury associated with significant morbidity
    1. Average hospitalization stay: 10 to 24 days
    2. Amputation required in 64% of cases
    3. Permanent Impairment in U.S.: 2000 children per year
  3. Most common sites of injury
    1. Distal upper extremity
    2. Distal lower extremity

III. Management: General

  1. Immediate vigorous surgical debridement
    1. Pulsed lavage
    2. Remove particulate debris
  2. Obtain intraoperative cultures
  3. Antibiotic prophylaxis as below
  4. Tetanus prophylaxis
    1. Tetanus immune globulin
      1. Indicated for <3 prior doses of Tetanus Toxoid
    2. Tetanus Toxoid Indications
      1. Unknown status
      2. No Tetanus Toxoid in last 5 years
  5. Observe for adequate Wound Healing
    1. Maximize healthy granulation tissue
    2. Consider skin grafting if necessary

IV. Management: Secondary Infection

  1. Common organisms (polymicrobial in many cases)
    1. Staphylococcus
    2. Diphtheroids
    3. Escherichia coli
    4. Enterococcus faecalis
    5. Pseudomonas species
    6. Seratia marcescens
    7. Anaerobic organisms
    8. Fungal organisms
  2. Antibiotic Prophylaxis (broad spectrum for 5-10 days)
    1. Cefazolin and
    2. Aminoglycoside
      1. Add for severe injury or open Fracture
  3. Observation for infection
    1. Consider re-culturing 24 to 72 hours after injury

V. Prevention

  1. Avoid ride-on lawn mower use under age 14 years
  2. Train adolescents on mower prior to use
  3. Young children should remain indoors during mower use

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