Doug Dembinski

A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non–self-inflicted (NSI) GSWs. We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018. We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, P = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, P = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, P = .08). Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.

Objectives/Hypothesis: During phonation, skewing of the glottal flow waveform (Q) refers to a phenomenon that occurs when the flow decelerates more rapidly than it accelerates. This skewing is clinically important because it increases the glottal efficiency, which is defined by the acoustic intensity (sound pressure level) divided by the subglottal pressure. Current theoretical models predict that the only mechanism to cause skewing of Q involves changes in the vocal tract inertance. The purpose of the current work is to show that other factors at the vocal fold level can also cause skewing of Q and to determine if the acoustic intensity is correlated with maximum flow declination rate.Study Design: Basic science.Methods: Intraglottal geometry and velocity measurements were taken in five canine larynges at the mid‐membranous plane using 2‐dimensional particle imaging velocimetry (PIV). The flow rate at the glottal exit was computed from the PIV measurements for low, medium, and high subglottal pressures.Results: Vortices form in the superior aspect of the divergent glottis during closing. These vortices produce negative pressure that increases both the maximum value of Q and the rapid deceleration of the flow. The skewing of the flow rate is increased as the intraglottal vortices are increased by increasing the subglottal pressure. The increase in the acoustic intensity is highly correlated with certain properties of the flow rate waveform, such as maximum flow rate.Conclusion: Flow skewing and the acoustic intensity can be increased by increasing the intraglottal vortices.Level of Evidence: N/A. Laryngoscope, 125:383–388, 2015