Punctures are hole-shaped wounds caused by pointy objects such as needles and nails. This is especially true if theres a lot of bleeding or if bleeding lasts for more than 20 minutes. Bleeding does not stop with direct pressure, Bleeding is the result of a severe accident, and possibly numbing the wound area before stitching, using skin glue, sutures, or stitches, or possibly deciding not to close it depending on its location and potential for infection, such as Tylenol, penicillin, or another antibiotic if there is an infection or high risk of developing one. ." 5. Facial stitches may be removed after four days and no later than seven days because healing occurs faster in this location of the body, and additional scarring from the stitches is a bigger concern. [18] Until this layer has formed, the exposed nail bed is highly sensitive, and is typically covered with a non-adherent dressing, as an ordinary dressing will stick to the nail bed and cause pain upon removal. Even though the wound is open and raw, direct pressure is the best way to stop bleeding. Change the dressing once a day or if it gets dirty or wet. If skin glue was used, don't put any creams, lotions, or antibiotic ointments on it. Treatment for a mild skin avulsion wound is similar to other types of at-home wound treatments. If there is still a skin flap attached to the wound, and the flap is healthy, your doctor may be able to reattach the skin into its original place. A keloid is a thick swollen scar with a ropelike quality. What are the new treatments for plaque psoriasis? Skin avulsions are often caused by trauma. In case you get into an accident, knowing how to spot the type of wound and the treatment needed will help you manage your injury and avoid infection. Stitches. Infection prevention will depend on the type of injury. This may be done by first washing the adjacent skin with soap and water and removing crusted blood with diluted hydrogen peroxide. The above information is an educational aid only. Deep scratches on the skin of the children's elbow hand. Treatment of an avulsion fracture typically includes resting and icing the affected area, followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. In rare cases, if the bone fragment and main bone are too far apart to fuse naturally, surgery may be necessary to reunite them. For more minor cases, you may just need a combination of compression bandages, physical therapy, and rest. Avulsions typically occur during violent accidents. Last medically reviewed on January 3, 2018. All rights reserved. Dispose of old dressings and bandages in plastic bags. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Accessed May 22, 2017. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. They usually occur during violent accidents such as car crashes, explosions, and other incidents that involve trauma. Miller MD, et al. If you have even a small puncture wound, visit your doctor to get a tetanus shot and prevent infection. A nail bed injury almost always accompanies a partial or complete fingertip avulsion [ 2-4 ]. In a skin avulsion injury, all layers of skin are gone from the wounded area. The ear is particularly vulnerable to avulsion injuries because of its position on the side of the head. Call your doctor to decide whether you need a tetanus booster. You should have had a tetanus booster immunization within the last 10 years if you have a simple, clean-cut, or within the last five years if you have a more complex or dirty cut. Eyelid avulsion: Eyelid avulsions are the result of some or all of the eyelid being torn away. DOI: ncbi.nlm.nih.gov/pmc/articles/PMC4753839/, symbiosisonlinepublishing.com/surgery/surgery01.php, ijri.org/article.asp?issn=0971-3026;year=2014;volume=24;issue=3;spage=288;epage=290;aulast=Nair, Achilles Tendon Rupture: Symptoms to Look For, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, Ruptured Spleen: Symptoms and Treatment in Adults and Children, accidents with industrial or farm equipment, draining any built-up fluid from the lesion, sclerotherapy, which involves injecting blood vessels with medication to make them shrink, oozing around the wound, especially if its yellow or smells bad. Our website services, content, and products are for informational purposes only. 1,225 puncture wound stock photos, vectors, and illustrations are available royalty-free. information and will only use or disclose that information as set forth in our notice of [1] The term most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures (i.e., subcutaneous tissue, muscle, tendons, or bone ). These wounds often require surgery to repair. Avulsions and degloving injuries will almost always need surgical intervention to heal properly. But too much bleeding, When you get a cut or other wound, it can be hard to tell when to treat it at home and when to get stitches. We avoid using tertiary references. Subscrible to MakatiMeds online newsletter to get notified on latest updates, and amazing deals and promos. Every person most likely had an open wound in the past, whether it is a small scratch from the playground or a freak accident at work. You can learn more about how we ensure our content is accurate and current by reading our. If any X-rays were done, you'll be told of any changes that may affect your care. Puncture wounds: First aid. These guidelines will help you care for your wound at home: Keep the wound clean and dry for the first 24 to 48 hours, or as your healthcare provider advises. Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care. The nail bed will be sensitive until the hard layer forms. If your avulsion wound is deep but not too wide, your doctor may be able to close it up with stitches, also called sutures. In some cases, this may be done surgically, such as to relieve chronic ingrown toenails. exclude or treat people differently because of race, color, national origin, age, disability, sex,
Upload. (See 'Paring, trimming, and grinding' above.) Apart from heavy bleeding, some cases of avulsions can also lead to the loss or dislocation of limbs. This ensures you receive the most appropriate treatment and reduces your risk for complications and infection. [13] More severe injuries require reconstruction, however, this usually results in some loss of function and subsequent surgeries may be necessary to improve structure and function. Injuries typically heal from the bottom up and from the edges in. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. There are basically four types of open wounds: Although you can treat some abrasions and minor laceration wounds at home, you should see a health care provider if: Note that puncture wounds may not bleed very much, but they can cause serious damage if deep enough. Talk with your healthcare provider before using these medicines if you have chronic liver or kidney disease. In some cases, you may need surgery. You may need to stay in the hospital for days or weeks, depending on the injury. Minor wounds can be treated at home. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Don't wash or rub the stitches directly. 640 Abrasion Wound Stock Photos - Free & Royalty-Free Stock Photos from Dreamstime 640 Abrasion Wound Stock Photos, Images & Pictures Most relevant Best selling Latest uploads Within Results People Pricing License Media Properties More Safe Search wound puncture wound laceration burn wound bruise wound aloe vera skin abrasion laceration wound [22] For intractable pain, a procedure called dorsal root entry zone (DREZ) lesioning can be effective. An incision is a clean and straight wound caused by a knife, broken glass, or any sharp object. by using a clean bandage or piece of gauze with tape. Thank you, {{form.email}}, for signing up. In: Pfenninger and Fowler's Procedures for Primary Care. The bottom line is to use common sense. This does not include baby teeth that fall out naturally. Acta Ophthalmol. Injury where a body structure is torn off, This article is about avulsion injuries other than. Mayo Clinic, Rochester, Minn. May 24, 2017. You need medical attention if you have a deep cut or if youre bleeding a lot. DOI: Jones M, et al. It can. Degloving can affect any part of the body, such as the fingers, feet, or hands. Jeng, S.F., & Wei, F.C. You should know the following facts: A physical exam will include the following: An x-ray may be ordered if foreign objects or an underlying broken bone is suspected. These sports involve many forceful movements such as sprinting, kicking, leaping, suddenly starting or stopping, and more. (2018). A 2017 review estimated that up to one-third of people with closed degloving injuries may have a delayed diagnosis. health.vic.gov.au/edfactsheets/downloads/care-of-open-wounds-cuts-and-grazes.pdf, mayoclinic.org/first-aid/first-aid-puncture-wounds/basics/art-20056665, Do I Need Stitches? You will need to keep it covered to prevent infection or more injury. Your doctor may also prescribe penicillin or another antibiotic if theres an infection or high risk for developing an infection. National Institute of Neurological Disorders and Stroke. Applying pressure can often control bleeding quickly. A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults. Nickerson TP, et al. 2011;44(2):227-236. doi:10.4103/0970-0358.85344. Do not aggressively scrub the wound. This can range from a mild bump or bruise to a traumatic brain injury. It may seemingly be harmless, but if the wound is contaminated, antibiotics or a tetanus shot may be needed. In: Essential Orthopaedics. The person with the avulsion injury will need immediate medical care, but these first aid steps can be done as soon as possible, even before medical treatment is available. This content does not have an English version. Pfenninger JL, et al. An avulsion is a serious skin trauma. Smaller injuries can be treated at home, while more significant injuries will need medical care. Please see our Nondiscrimination
These can dissolve the glue. [25] A nail avulsion is performed to remove all or part of a chronic ingrown nail. What Is the Prognosis for a Cut or Laceration? Otherwise, leave it on for the first 24 hours, then change it once a day or as often as the healthcare provider says. If there is no flap of skin available to reattach, your doctor may opt for a skin graft instead. Laskowski ER (expert opinion). A ruptured Achilles tendon is not uncommon for athletes and can cause a great deal of pain. An incision is a cut with clean edges. Although you can treat some wounds at home, you should see a doctor if: Your doctor may use different techniques to treat your open wound. The best way to speed along your recovery from an avulsion wound is to take proper care of your wound after youre sent home. Falls, accidents with a sharp object, and car accidents are the most common causes of open wounds. The most common short-term complication was wound dehiscence (21.4%). A skin avulsion, also called "degloving," occurs when tissue is not just separated but forcefully torn away from the body. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Avoid products with aspirin since they can cause or prolong bleeding. Learn more about these serious fractures, how theyre treated, and what to expect. Philadelphia, Pa.: Saunders Elsevier; 2014. https://www.clinicalkey.com. Thoroughly rinse out any dirt or debris from the wound and clean the wound with soap and water. [27][28] However, it often requires additional surgeries to retain function[27] and botulinum toxin injections have been shown to be more effective than surgical avulsions in treating benign essential blepharospasm, while causing fewer complications.[28]. It is made up of macrophages, which help to remove debris and release cytokines. Avulsion hi-res stock photography and images - Alamy Avulsion Stock Photos and Images (275) See avulsion stock video clips Quick filters: Cut Outs | Vectors | Black & white avulsion fracture avulsion injury avulsion fracture leg avulsion fracture fibula avulsion fracture spine RM 2BEH6J3 - Avulsion Bone Fracture, Illustration Most open wounds are minor and can be treated at home. Inflammation from wound healing and stitches can cause minor redness around the wound edges and is normal. Healthline Media does not provide medical advice, diagnosis, or treatment. You may have stitches. Fracture care. Your wound splits open or does not seem to be healing. It is commonly caused by accidents involving sharp or rough objects that cut through the skin and leave some form of trauma. If the section of avulsed tissue is available, it can sometimes be repaired. Avulsion. Apply ice if you have bruising or swelling, and avoid picking at scabs. You should not drive right after an avulsion fracture when you still need emergency care. After three days the bandage may be removed, except in the case of drainage. So you don't need to pull it off. & Accessibility Requirements. If these symptoms start to manifest, consult with a healthcare professional as soon as possible. This will help to make sure that the infection has cleared. Verywell Health's content is for informational and educational purposes only. Avoid tourniquets unless bleeding cannot be controlled and medical care will not be available for several hours. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Skin Tear (Skin Avulsion) A skin tear (skin avulsion) is a tearing of the top layer of skin. Patterns and management of degloving injuries: A single national level 1 trauma center experience. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The wound is still not appearing to heal or has even gotten worse after a few days of care. However, the affected area will need cleaning since it may have been exposed to foreign substances such as dirt and bacteria. Treating closed degloving injuries also depends on the extent of the injury. An avulsion fracture is the most common type of avulsion in athletic-related injuries. Theyre also often accompanied by other serious injuries, such as broken bones, that require emergency treatment. A wound of this type cannot be stitched closed because there is tissue missing. Keep your wound clean and protected to prevent infection and speed healing. Stitches to the skin surface can help to stop bleeding, protect underlying tissues, and lessen scarring. Stitches or staples are usually taken out in 5 to 14 days. Isolated medial rectus muscle rupture after a traffic accident. Watch for signs of infection such as redness, swelling, and pus. As you recover, make sure to tell you doctor if you have any of the following symptoms: Untreated closed degloving injuries can also lead to severe tissue death. The treatment of a cut or laceration depends upon the severity of the wound. (2000). Punctures may not bleed much, but these wounds can be deep enough to damage internal organs. If stitches or staples were used, check the wound every day. Just as at home, the first step is to stop the bleeding. When you have experienced an avulsion or degloving injury, you might also have other injuries as well, such as laceration. It is marked by heavy, rapid bleeding and a noticeable absence of tissue. We comply with applicable Federal civil rights laws and Minnesota laws. Signs and Symptoms. Mayo Clinic Staff. doi:10.1016/j.injury.2021.04.042, Zacharia B, Roy A. Usually, the glue will flake off in about 5 to 10 days by itself. The most significant health threat with minor wounds is an infection, so it is essential to clean and treat the injury properly. Tooth avulsion. It is safer to have someone drive you to urgent care or the emergency department, or call for an ambulance. A skin graft is done by taking a patch of healthy skin from one part of the body and transplanting it to the injured site., Most skin grafts only take the top to layers of skin, leaving the hypodermis behind. A spinal cord injury is damage to the spinal cord that can have a lasting and significant impact on your daily life. Some people faint at the sight of their own blood (this is a neurological reaction in which a reflex slowing of the heart causes a. Soueid, N.E., & Khoobehi, K. (2006, January). 2021 Feb 27:S1008-1275(21)00031-6. doi:10.1016/j.cjtee.2021.02.008, Schilders E, Mitchell AWM, Johnson R, Dimitrakopoulou A, Kartsonaki C, Lee JC. This most often happens when you suddenly change direction. General principles of orthopedic injuries. [26] Facial nerve avulsion is used to treat the involuntary twitching involved in benign essential blepharospasm. In order to do this, the skin flap must still have good blood flow. Photos 245 Videos 69 Users 7. Not all emergency centers may have the expertise for complex skin repair. Thousands of new images every day Completely Free to Use High-quality videos and images from Pexels. Sorg H, Tilkorn DJ, Hager S, Hauser J, Mirastschijski U. DOI: Nair AV, et al. Different bandages are chosen for their different material properties. Just like any other injury, open wounds can be classified into different categories. You may receive a tetanus shot if you have a puncture wound. Closed degloving injuries arent always visible. Pain typically accompanies a wound. Nail avulsion is a procedure whereby all or a portion of the nail plate is removed from the nail bed . This can happen due to everyday activities, like using a knife to chop food or running and tripping in open-toed shoes.. (2015). But don't soak the area in water (no baths or swimming) until the stitches or staples are taken out and your provider says it's OK. There is a problem with This is because they involve large amounts of blood loss and tissue death. Doctors usually make incisions when performing surgery, but it can be lethal when suffered during an accident. It is important to realize that a scar will often look red and swollen after suture removal but may fade considerably for up to one year. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Use direct pressure and elevation to control bleeding and swelling. This makes them harder for doctors to diagnose. In a brachial plexus avulsion, the root of the nerve is detached from the spinal cord. McCord, C.D. [4] The most common cause of ear avulsions is human bites, followed by falls, motor vehicle collisions, and dog bites. General care instructions for avulsion wounds include: SOURCES:Case Reports in Ophthalmology: Management of Traumatic Lower-Eyelid Avulsion and Complete Loss of the Lacrimal Canaliculus: A Case Report.Cleveland Clinic: Avulsed Tooth, Skin.Dignity Health: Stitches.Laryngoscope Investigative Otolaryngology: Auricular avulsion injuries and reattachment techniques: A systematic review.Indian Journal of Dermatology, Venereology, and Leprology: Nail avulsion: Indications and methods (surgical nail avulsion).Johns Hopkins Medicine: Brachial Plexus Injury.Journal of Emergencies, Trauma, and Shock: The therapeutic challenges of degloving soft-tissue injuries.Main Line Health: Avulsions.Mayo Clinic: Avulsion fracture: How is it treated?Mount Nittany Health: Skin Tear (Skin Avulsion).Mount Sinai: Skin graft.Smithsonian Magazine: Ask Smithsonian: How Does Skin Heal?University of California Irvine Health: Home wound care dos and donts.. An open wound is an injury involving an external or internal break in body tissue, usually involving the skin. Puncture. Ingrown & Infected Toenails Treatment & Removal. Cleaning with gentle soap and water will help reduce the chance of bacterial infection. 8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and More. After cleaning and possibly numbing the area, your doctor may close the wound using skin glue, sutures, or stitches. If the avulsed tissue is not available, the injury is often treated like a burn, in which layers of skin have been severely damaged or lost. Home care. This will restart the bleeding in many cases, and that's OK as long as the bleeding is minimal. (1988, June). In serious cases, you may need surgery to remove infected tissue and sometimes the surrounding tissue as well. Although the healing may not look pretty, it prevents infection and the formation of abscesses. Free Avulsion Wound Photos. Then, reapply the bandage or dressing as you were told. All rights reserved. Be careful not to let the bandage stick to the oozing wound. When changing dressings, be very careful to avoid tearing delicate skin. A hangmans fracture is a serious, but treatable injury. On this Wikipedia the language links are at the top of the page across from the article title. (2017). 2017;48(1):137-141. doi:10.1016/j.injury.2016.10.026, Liu H, Liu J, Wu Y, et al. Clotting will ultimately help to stop the bleeding. Cuts in the same direction as your natural skin lines (wrinkle lines) are less visible. Cytokines help to activate fibroblasts, which will make collagen, trigger endothelialization, and help with the formation of new blood vessels, a . A case report of traumatic perineal degloving injury. Rinse the wound: Use water or saline solution. [23] To minimize damage to the root, the tooth should be kept in milk or sterile saline while it is outside the mouth.[23][24]. That's where the term comes from. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Pressure bandages or splints may be applied, depending on the underlying injuries. by gently pouring lukewarm water over the affected area for a couple of minutes. Avulsion An avulsion is a partial or complete tearing away of skin and the tissue. If we combine this information with your protected Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. This kind of wound is not deep, so there is little to no bleeding that occurs. include protected health information. Keep the wound covered and clean while healing. (2016). However, if you notice a rash or redness due to the antibiotic ointment, stop use. Animal bites, for example, pose a high risk of infection. Accessed May 22, 2017. Nondiscrimination
Call your doctor immediately if youve had a puncture, deep laceration, or serious accident and youre showing signs of significant bleeding or infection. An avulsion that wraps all the way around an extremity and causes the layers of tissue to pull away is called a degloving injury. [16] Microvascular surgery is another method of repair but is rarely used to treat eye avulsions. Scarring is a big concern. Healthline Media does not provide medical advice, diagnosis, or treatment. If tendons are affected, an incision will cause heavy bleeding and possibly cause permanent damage. Avoid punctures and incisions by ensuring that the environment is free from hazards and that sharp objects are handled with care. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Degloving injuries are serious and sometimes fatal. You have heavy bleeding or bleeding that does not stop after 10 minutes of holding firm, direct pressure over the wound. The nail may be completely or partially torn off after a trauma to the area. (2014). However, size, location, the amount of, A cut finger can happen quickly and without warning. Your toe or finger may be sore after treatment. DOI: Hakim S, et al. You may opt-out of email communications at any time by clicking on Clean as close to the stitches as you can. First, wash and disinfect the wound to remove all dirt and debris. Nearly everyone will experience an open wound at some point in their life. Sometimes, a bullet can cause a puncture wound. Totally avulsed ear: New technique of immediate ear reconstruction. If the area needing coverage is large, the donor skin can be cut into a mesh pattern to allow for more stretch.. An avulsion is characterized by a flap. From outside in, they are the epidermis, the dermis, and the hypodermis. Losing a toenail or fingernail because of an injury is called avulsion. Despite its name, the infection has nothing to do with poison, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. information submitted for this request. Avulsion may happen on your finger or toe. Treatment of essential blepharospasm: Comparison of facial nerve avulsion and eyebrow-eyelid muscle stripping procedure. Degloving injuries are often life threatening. [21] Shoulder trauma during motor vehicle collisions is another common cause of brachial plexus avulsions. After 3 days you can keep the bandages off the wound, unless told otherwise, or there is continued drainage. The treatment you need will depend on the severity of your injury. License. 583782460. The lesions can fill with lymph fluid, blood, and fat. Common causes of an avulsion fracture involve injuries from playing contact sports like boxing, football, and lacrosse. A puncture is a small hole caused by a pointy object like a nail, needle, or bullet (bullet puncture). Catawba Valley Healthcare is a 501(c)(3) comprehensive non-profit healthcare providerand is not affiliated with Catawba Valley Health Systems (CVHS), also located in Hickory. (2014). In the case of deep lacerations, bleeding can be rapid and extensive. deSousa, J.L., Leibovitch, I., Malhotra, R., O'Donnell, B., Sullivan, T., & Selva, D. (2007, December). This process may require you to pack your wound with gauze. After the skin is stitched back into place, tubes will likely need to be used to remove excess fluid. Crutches and slings help protect the injured area, prevent further injury, and heal the area in the right position. [14] Eyelid avulsions are repaired by suturing after a CT scan is performed to determine where damage to the muscles, nerves, and blood vessels of the eyelid has occurred. Theres usually not a lot of bleeding, but the wound needs to be scrubbed and cleaned to avoid infection. Skin scrapes and abrasions, often called raspberries, are usually bright red and painful and are sometimes difficult to treat. [22], During a tooth avulsion, a tooth is completely or partially (such that the dental pulp is exposed) detached from its socket. Avulsions and all degloving injuries are significant emergencies that require immediate emergency medical attention. if needed and as directed. If the bleeding was very difficult to stop and you are concerned that it will be out of control if you rinse the wound, then skip this step while you are waiting for professional help. Other Types of Wounds. Tooth avulsions refer to situations in which a tooth is completely removed from its socket, usually with the root still attached. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. What Are the Best PsA Treatments for You? Successful reattachment of an almost totally avulsed ear: Use of the fluorescein test. Your doctor may have removed the nail, put part of it back into place, or repaired the nail bed. It occurs when bacteria are in the bloodstream. Direct injection of anesthetic into the wound, Injection into a regional nerve - called "nerve block" - (for cuts to the fingertip, the nerves at the finger base are often blocked with a series of shots). If you have stitches, ask when to return to have them removed. What Exams and Tests Assess Cuts and Lacerations? To fix this injury and to be able to continue climbing, many climbers will apply sports tape to the flapped finger to cover up the sensitive area of broken skin. 18 December, 2018. DOI: Mello DF, et al. Abrasion. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Keep the wound clean and dry for about 24-48 hours. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. An open wound involves an external or internal break in your body tissue, typically involving the skin. If youre spending time outdoors, use a sunscreen thats sun protection factor (SPF) 30 on the area until its completely healed. How to treat an avulsion wound at home. Skin wound healing: An update on the current knowledge and concepts. In an avulsion, all layers of skin are removed, so there is no way for the injury to heal from the bottom up. You feel like there is an object stuck in your wound. Knee Surg Sports Traumatol Arthrosc. Download and use 200+ Avulsion Wound stock photos for free. Suprafascial avulsions are those in which the depth of the removed skin reaches the subcutaneous tissue layer, while subfascial avulsions extend deeper than the subcutaneous layer. Gently remove any dirt or other particles from the wound if you can. Any time layers of skin have been torn off to expose muscles, tendons and tissue, it is called an avulsion. Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study.