• Title/Summary/Keyword: Major trauma

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Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

  • Lazzeri, Davide;Huemer, Georg M.;Nicoli, Fabio;Larcher, Lorenz;Dashti, Talal;Grassetti, Luca;Li, Qingfeng;Zhang, Yixin;Spinelli, Giuseppe;Agostini, Tommaso
    • Archives of Plastic Surgery
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    • v.40 no.1
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    • pp.44-50
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    • 2013
  • Background The aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects. Methods A comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremity reconstruction were excluded from meta-analysis. Results From the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed. Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.

Drinking Pattern and Nonfatal Injuries of Adults in Korea (우리나라 성인의 음주행태와 비치명적 손상의 연관성)

  • Lee, Won Kyung;Kim, Yoon
    • Journal of Trauma and Injury
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    • v.22 no.2
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    • pp.233-241
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    • 2009
  • Purpose: Alcohol is a major risk factor for injuries, but little is known about the relationship between chronic drinking pattern and injuries. The purpose of this study was to evaluate the incidence of alcohol-related injuries and the differences in the characteristics of the injuries between Alcohol Use Disorder Identification Test (AUDIT) categories. Methods: Among a representative sample of the third Korea National Health and Nutrition Examination Survey. 7,697 adults answered questions about injuries, drinking patterns, and socioeconomic status. Incidences of alcohol-related injuries and of non-alcohol-related injuries were calculated, and the relative ratio of injuries between AUDIT categories was analyzed. Results: The incidences of all injuries and alcohol-related injuries were 69.2 and 6.8 per 1000 person-year. After adjustment, the incidences of non-alcohol-related injuries showed no differences between AUDIT categories. But the adjusted relative ratios (RRs) of alcohol-related injuries were 3.73 (95% CI: 1.54~8.99) and 7.70 (95% CI: 3.61~16.44) for risk drinkers and for alcohol-dependent drinkers respectively. No specific body part could be identified as being frequently injured in cases of risk drinkers and alcohol-dependent drinkers. In contrast, the adjusted RRs of fractures, bruises, and open wounds were 1.76 (95% CI: 1.03~3.02), 1.73 (95% CI: 1.15~2.61), and 1.85 (95% CI: 1.17~2.93) for alcohol-dependent drinkers. Assaults occurred 4.66 times more frequently in alcohol-dependent drinkers. Conclusion: Alcohol-related injuries occur more frequently as the person becomes more dependent on alcohol. Fractures, Bruises, open wounds, and assaults occur more frequently in alcohol-dependent drinker. This study suggests that efforts should be carried out in the ED to screen and treat alcohol-use disorders associated with patients injured after drinking.

Penile Reconstruction Using a Radial Forearm Free Flap with Modified Biemer's Method (변형 Biemer 방법에 의한 요골부위 전박 유리피판을 이용한 음경재건)

  • Kim, Seong-Deok;Ha, Bom-Joon;Mun, Goo-Hyun;Hyon, Won-Sok;Bang, Sa-Ik;Oh, Kap-Sung
    • Archives of Reconstructive Microsurgery
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    • v.11 no.2
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    • pp.146-152
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    • 2002
  • As the defects of the penis caused by trauma, surgical amputation, or congenital abnormality give the patients both psychological trauma and functional impairment, reconstruction of the penis is mandatory. Radial forearm free flap is reliable one-stage procedure, which can reconstruct both the phallus and the urethra. Chang and Whang's adaptation of the "tube-in-a-tube" concept and its incorporation into a free flap design represented a major advance in microsurgical phallic construction. Biemer described a modification of the radial forearm flap design in which the neourethra was centered over the radial artery, but the phallic shaft was separated into two paraurethral swatches. The authors have performed one-stage penile reconstruction in two patients since 1998, using a radial forearm free flap. Our present design incorporates the original Biemer triple skin island and includes a fourth distal island for neoglans. One case was the amputation of the penis from felonious assault and the other case was the iatrogenic penile amputation from repetitive urologic surgery for congenital hypospadia. All patients showed aesthetically acceptable results and good tactile sensory recovery. Severe complications such as necrosis, fistula, or urethral stricture were not occurred. Biemer's method modified by the authors is reliable one-stage penile reconstruction providing good aesthetic and functional results.

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Validation of guidelines for field triage of injured patients for major trauma in patients of brain and spinal injury

  • Lee, Sung Kgun;Kang, Jeong Ho;Song, Sung Wook
    • Journal of Medicine and Life Science
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    • v.17 no.1
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    • pp.7-15
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    • 2020
  • The field triage guidelines have been widely implemented in the Korean trauma system. This study aimed to evaluate and validate whether it is reliable to use the field triage guidelines for predicting severe traumatic brain injury (TBI) and traumatic spinal injury (TSI) patients. This study retrospectively analyzed in-hospital cohort registries of all TBI and TSI patients, who visited the emergency department (ED) of the Jeju National University Hospital from 1 January 2013 to 31 December 2015. The primary outcome was defined as TBI and TSI patients with an injury severity score (ISS)>15. Secondary outcomes were defined as cases in which one or more of the following conditions: in-hospital death, ISS>15, admission to the intensive care unit, emergency surgery. We enrolled 14,889 TBI and TSI patients who visited ED, of which 7,966 (53.5%) were triage positive. The overall sensitivity, specificity and area under the curve (AUC) of the full cumulative field triage guidelines step's model (Step 1+3+4 criteria) for primary outcome were 82.8%, 47.0%, and 0.646, respectively. In the results for secondary outcomes, the specificity did not show a significant difference, but the sensitivity decreased to 66.5% and AUC to 0.568. The results of this study suggest that further optimization of the field triage guidelines is needed to identify high-risk TBI and TSI patients.

Prosthetic reconstruction of maxillary defect resulting from a traumatic fall in an elderly patient: A case report (낙상에 의해 상악 전치부에 외상을 입은 노인 환자에서 수술을 배제하고 고정성 보철물을 이용하여 수복한 증례)

  • Bae, Yoonjoo;Choi, Sunyoung
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.1
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    • pp.75-80
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    • 2019
  • Fall is the most common cause of trauma in the elderly and a major reason of dental injury. Maxillary anterior region is the most vulnerable area to the traumatic fall. Loss of teeth and adjacent tissue in this area results in maxillofacial defects and inappropriate maxillomandibular relationship. Reconstruction of the loss requires comprehensive and careful planning to fulfill not only functional but also esthetic demand. Prosthetic approach can avoid surgically extensive intervention, reducing both treatment cost and time. This clinical report describes a 78-year-old woman with the loss of teeth and alveolar bone in maxillary anterior region due to a traumatic fall, rehabilitated with a metal-ceramic fixed dental prosthesis using gingival porcelain.

Epidemiologic Changes of Facial Bone Fracture before and after Coronavirus Disease 2019: A Level 1 Trauma Center in Korea

  • Jeong Ho Kim;Chae Eun Yang;Sug Won Kim;Jiye Kim
    • Archives of Plastic Surgery
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    • v.50 no.1
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    • pp.37-41
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    • 2023
  • Background The coronavirus disease 2019 (COVID-19) outbreak has had a major impact worldwide. Several countries have implemented restrictions on social interaction ("social distancing"). Several studies have reported that the epidemiology of trauma patients, such as those with facial bone fractures, has changed after COVID-19 pandemic. This study aimed to further explore these specific changes. Methods This was a retrospective study of patients who presented to a single institution with facial bone fractures between January 1, 2016, and December 31, 2020. Baseline patient demographics, clinical information, type of fracture, etiology, and operative management were compared before and after COVID-19. Results Of all cases, 3,409 occurred before COVID-19, and 602 occurred after COVID-19. Since the outbreak of COVID-19, the number of patients with facial fractures has not decreased significantly. A significant increase was noted in fractures that occurred outdoors (p < 0.001). However, a decrease was observed in operative management between the groups (p < 0.001). There was no significant difference in the proportion of assault, fall-down, industrial accident, or roll-down. In contrast, the proportion of traffic accidents and slip-down categories increased significantly (p < 0.05). Moreover, a significant decrease was found in the proportion of the sports category (p = 0.001) Conclusions It was confirmed through this study that COVID-19 pandemic also affected epidemiology of facial fractures. Focusing on these changes, it is necessary to develop safety measures to reduce facial fractures.

Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data

  • Mohammadreza Zakeri;Alireza Mirahmadizadeh;Habibollah Azarbakhsh;Seyed Sina Dehghani;Maryam Janfada;Mohammad Javad Moradian;Leila Moftakhar;Mehdi Sharafi;Alireza Heiran
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.2
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    • pp.120-127
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    • 2024
  • Objectives: The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. Methods: The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. Results: Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22). Conclusions: There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.

Traumatic Intimal Tearing of the Descending Thoracic Aorta -A Case Report- (외상성 하행흉부대동맥 내막 파열 -치험 1예 보고-)

  • Chang, M.;Jang, J.S.;Kang, M.S.;Cho, B.K.;Hong, P.W.
    • Journal of Chest Surgery
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    • v.13 no.3
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    • pp.269-273
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    • 1980
  • The rupture of the aorta commonly follows major blunt trauma to the thorax. It has markedly increased in recent years, paralleling the rising number of vehicular accidents. The most frequent site of rupture is the area of the isthmus, with the ascending aorta second. The diagnosis of the condition from clinical data is difficult, and aortography is used whenever aortic tear is suspected. We are presenting a case of patient who had intimal tearing of the thoracic aorta with multiple injuries. The patient underwent surgical repair 28 days after injury with left heart [LA-Femoral artery] bypass.

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Effect of Oxygen Concentration, Physical Trauma on Proliferation of Umbilical Cord Blood-derived Mesenchymal Stem Cells (산소 농도의 변화와 물리적 손상이 제대혈 중간엽 줄기세포의 증식에 미치는 영향)

  • Park, Ran-Sook
    • The Korean Journal of Food And Nutrition
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    • v.24 no.4
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    • pp.803-807
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    • 2011
  • Human umbilical Mesenchymal Stem Cell(uMSC) has been known as one of major component to regenerate connective tissues such as bone, cartilage, fat and others. The effect of low(5%), normotensive(20%) oxygen and freezing-thawing damage on proliferation of uMSC were investigated. low oxygen concentration culture of uMSC resulted in enhanced proliferation significantly($p$ <0.05) than 20% of oxygen culture. After the freezing-thawing injury to uMSC, 5% oxygen culture showed marked proliferation of uMSC than that of 20% oxygen($p$ <0.05) in the 5th passage of uMSC. Expression of antioxidant enzymes such as superoxide anion 1 and glutathione peroxidase 1 appeared marked in 20% oxygen cultured uMSC, which suggest oxidative stress could induce less proliferation of uMSC. Above findings would suggest proliferation of uMSC in 5% of oxygen will give more yields.

A Case Study with Carbon Arc Therapy on Recissive Dystrophic Epidermolysis Bullosa-mitis (탄소방전등(Carbon Arc)을 이용한 mitis형 열성 이영양성 수포성 표피 박리증 환자의 치험 1례)

  • Kim, Ji-Hyon;Kang, Eun-Kyo;Jeon, Seong-Ha;Kwon, Kang
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.21 no.2
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    • pp.154-164
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    • 2008
  • Epidermolysis Bullosa(EB) is rare, chronic mechanobullous disease, which easily produce bulla by minor trauma or spontaneously. There are three major forms of Epidermolysis bullosa - Epidermolysis bullosa simplex, Junctional epidermolysis bullosa, Dystrophic epidermolysis bullosa. This report is on the 21-year-old female patient who has Dystrophic epidermolysis bullosa(Recessive Dystrophic epidermolysis bullosa-mitis). The Korean medical treatments such as acupuncture and herbal medication were used, with light therapy : Carbon Are, which is known for effect of dermal resuscitation. As a result, Carbon Arc and Korean medical treatment's effect of dermal resuscitation is proved in this study. But more cases are necessary for establishing more effective treatment methods.

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