Penetrating facial injury from angle grinder use: management and prevention
© Carter et al; licensee BioMed Central Ltd. 2008
Received: 23 May 2007
Accepted: 23 January 2008
Published: 23 January 2008
Injuries resulting from the use of angle grinders are numerous. The most common sites injured are the head and face. The high speed disc of angle grinders does not respect anatomical boundaries or structures and thus the injuries produced can be disfiguring, permanently disabling or even fatal. However, aesthetically pleasing results can be achieved with thorough debridement, resection of wound edges and careful layered functional closure after reduction and fixation of facial bone injuries. A series of penetrating facial wounds associated with angle grinder use are presented and the management and prevention of these injuries discussed.
RoSPA – HASS/LASS data
Angle Grinder Injuries
In each of the cases the wounds were debrided with saline and wound edges heavily laden with particulate matter were excised. Oral mucosal and muscle layer closure was performed using Vicryl (polyglactin 910) resorbable sutures. Skin closure was preformed using non-resorbable monofilament interrupted sutures. Peri-operative intravenous Cefuroxime was administered for 24 hours followed by a seven day course of oral cephalosporin. Metronidazole was also administered in case 3. Chloramphenicol 1 percent ointment was applied to the skin wounds for seven days post-operatively. Wound review was performed at one, three and six weeks then at three, six and nine or twelve months.
Angle grinders are used around the world in large numbers to cut stone, metal and concrete . They are also used to grind pre-welded joints and remove unwanted fragments of metal or ceramics. The discs themselves rotate between 6000 and 15000 revolutions per minute, depending on the machine type and the disc diameter used. As well as facial injuries, the main injuries are to the upper limbs and, less commonly, the lower trunk .
The morphology of the wounds sustained using angle grinders tend to follow the shape of the cutting disc; most often curvilinear but may vary slightly depending on the angle of skin entry. Tissue loss is a common feature. The volume of tissue loss is directly dependent on the size of the disc used. Finding fragments of disc and the material being cut in the wound is pathognomic of angle grinder injuries . Therefore thorough debridement of contaminated wounds and excision of ragged edges is vital to optimal healing.
Injuries occur for a number of reasons. Firstly the wheel itself may kick back from the surface it is cutting. This will send the rotating disc toward the operator, parallel to the axis at which it is being used. Hence the face is most often at risk of a penetrating wound when looking down along the axis of the cuts being made . This feature is present in all of the cases reported as all exhibit oblique/parasagittal lacerations parallel to the cutting axis. This risk is increased markedly if the guard has been removed as highlighted in case 3.
Safe use of angle grinders
Safe use of angle grinders
Use the correct disc size and replace the disc when wear is obvious or the disc is chipped
Reduces the risk of a foreign body injury as a result of disc disintegration
Stop using if vibration is very apparent
Do not remove the guard unless for maintenance
Increases personal protection from direct and foreign body injury
Never use an angle grinder overhead
Stand perpendicular to the plane of the cutting wheel, i.e. cut in a para-coronal plane to reduce the risk of kick back towards the sagittal plane of the body
Always wear appropriate personal protective equipment/clothing (gloves, goggles, and hard-hat preferably with face shield)
The cases presented illustrate that the high speed disc of angle grinders does not respect anatomical boundaries or structures. Aesthetically pleasing wound closure can be achieved with thorough debridement, resection of wound edges and careful layered functional closure after reduction and fixation of facial bone injuries. However the injuries produced can often be disfiguring, permanently disabling or even fatal and are mostly preventable. We suggest that before using such a power tool that both manufacturer's guidance and national guidelines should be consulted.
Written informed consent was obtained from each patient for publication of this case series and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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