Although none of the editors of InsideSurgery are participating in his trauma care, we are following the reports that Tiger Woods was hurt in a motor vehicle accident this morning at around 2:25 am outside his home in Windemere, Florida.
According to WESH2, Woods was driving a late model Cadillac Escalade SUV when his car hit a fire hydrant and then tree.
Reportedly, his wife Elin Nordegren heard the crash and rushed to the scene where she broke a window in the car with a golf clube and pulled him out. When police arrived, he was lying on the ground, apparently semiconscious. It is not known if he was wearing his seatbelt at the time of the accident.
Generally, experienced rescue personnel counsel bystanders not to remove trauma victims from vehicles if there is no imminent threat of fire or drowning as moving a patient with a spinal injury that is not stabilized can cause a catastrophic spinal cord damage, sometimes leading to paralysis of the legs and/or arms.
Rescue personnel are trained to place victims in neck collars and to attach spinal boards to them to keep them relatively immobile while they are removed from the vehicle. This is the so-called “boarded and collared” procedure.
Apparently, alcohol was not thought to be involved but the Florida Highway Patrol is investigating and possible charges are pending.
Reports are now saying that Woods was treated for facial lacerations (cuts) to the face and lips and released.
Facial lacerations to the face are a commonly seen injury in MVAs and are often associated with front end collisions (especially when seatbelts are not worn) where the face impacts the steering wheel, windshield, or side windows.
The face is a highly vascular structure and even small superficial cuts can cause brisk bleeding.
It is not unusual for these injuries to look more severe than they actually are, particularly to non-trauma personnel.
The most worrisome blood vessel that can be injured in facial lacerations is the facial artery, which runs horizontally from the ear lobe area across the cheek to the lips.
The most worrisome nerve that can be injured in facial lacerati0ns is the facial nerve, which runs along the facial artery and controls many of the muscles of expression of the face.
Because of the desire for optimal cosmesis, facial lacerations are always repaired.
Generally, repair of lacerations on the face should be done by surgeons experienced in operating in this area, such as plastic surgeons, otolaryngologists, or oral surgeons.
The repairs can be difficult to do depending on how much underlying tissue has been lost. The wounds are always irrigated with devitalized tissue (dead tissue) removed before the repair is effected.
The deep layers are closed independently with a fairly small size absorbable suture such as 3-0 or 4-0 Vicryl.
The skin is usually closed with an interrupted monofilament suture such as 4-0 nylon with care taken to meticulously line up the skin edges.
The sutures closing the epidermal or top most skin edge are left in for 3-5 days depending on the age of the patient and the size of the laceration.
With lacerations to the lips, it is critically important that the vermilion border of the lips is lined up perfectly. Even a 1 mm misalignment of the lip tissue will cause an unsightly defect.
Because of the underlying ample blood supply to the face, facial lacerations rarely become infected. Patients with facial laceration should be given tetanus prevention if their shots are not already up to date.
However, because the face also contains a large nerve supply, lacerations to the face can be fairly painful.
Generally patients with facial lacerations secondary to a car crash will also have a CT of the facial bones to check for facial fractures. This is done using a protocol that uses fine cuts through the face to check for fractures of the eye sockets, maxilla, zygoma (cheek bones), and mandible (jaw).
Trauma patients who have facial lacerations and who are taken to a trauma bay will usually also get a head CT and cervical spine imaging.
It is most typical in a modern day trauma bay to get the imaging studies at the same time when the patient is put through the CT scan.
We will have more comments on this story as it develops.