Chest wall reconstruction following a speedboat propeller injury

Abstract

Propeller blade injuries to the chest are uncommon but can result in devastating injuries. We describe a case of a 44 year-old male scuba diver who was dragged by sea currents into the propeller of a speedboat. He suffered extensive chest wall trauma but narrowly escaped damage to major organs and vessels. He was admitted directly to the operating theatre. There was significant loss of bone from the manubrium, costal cartilages, overlying skin and muscle which were stripped off in 3 horizontal bands. During reconstruction the bony fragments were anchored to the nearest stable sternal or costal cartilage entities using steel wires, to achieve stability. The overlying muscle and skin were sutured directly to its opposite edge in layers and in an interdigitating fashion following the shape of the propeller blade lacerations. The patient remained intubated for 3 days in ITU and was transported back to his home country. He required a small skin graft to one area of necrosis but eventually made a full recovery with only his scars as a reminder of his accident. There have been other cases of propeller injuries in Malta but this is unique in being a severe injury to the chest, in which the patient made a full recovery. This report highlights the importance of legislation in preventing propeller injuries by restricting swimmer zones and introducing propeller guards or jet drive systems.