• Journal of Trauma and Injury
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• 제25권2호
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• pp.57-62
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• 2012

Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine, so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb$^{(R)}$. Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.48-51
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• 2011

Powered by compressed air, a nail gun is an essential alternative tool to a hammer on any construction site. This useful machine launches nails at high speed, automatically embedding them in a piece of wood in only a fraction of a second. In spite of its convenience, life-threatening and fatal nail gun injuries can occur when a nail gun is misused, such as in a suicide attempt, or when the operator has insufficient training because combustion nail guns are capable of firing projectiles at velocities higher than 150 m per second. Although injuries by nail guns are rarely reported, there have been reports of nail gun injuries to the head and the trachea in Korea. In the emergency room, the authors experienced a patient injured by an accidental shooting of a nail gun while working in construction. In that accident, a nail penetrated the patient's cervical vertebra through the left cheek. This report is aimed at studying medical treatment for patients with penetrating injuries caused by nail guns.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.201-204
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• 2008

Purpose: Now the CT scanner and PACS program proved to be an excellent instrument for detection and localization of most facial foreign bodies above certain minimum levels of detectability. The severity of injury in penetrating trauma on the face is often underestimated in physical examination. Wood, with its porous consistency and organic nature, provides a good medium for microbial agents. This is a report of our recent experience with wooden foreign bodies in the parotid gland imaged with CT. Methods: A 9-year-old boy was referred for evaluation of possible retained foreign body within his face. One day earlier, he had fallen, face down approximately 1 miter onto ground. He had subsequently undergone an exploration of his right parotido-masseteric area at an outside hospital with repair of a right facial laceration. Enhanced 2 mm axial and coronal CT scans were obtained through the face. Axial and coronal CT images were obtained with a General Electric(Milwaukee, Wis) 9800 CT scanner at 130 kV, 90 mA, with a 2 mm section thickness. Results: We finally decided the linear "gas" attenuation was a foreign body because of its linear configuration, which did not conform to that of an anatomic structure, and on the basis of articles that described a wood foreign body in the orbit as having the appearance of air. We found that wood was hypoattenuating($-464{\pm}27HU$). Conclusion: We recommend this type of software program for CT scanning for any patient with an injury on the face in which a foreign body is suspected.

• Journal of Chest Surgery
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• 제41권1호
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• pp.124-127
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• 2008

외상에 의한 하대정맥의 손상은 사망률이 매우 높으며, 1970년대 이후로 사망률의 개선이 거의 없는 실정이다. 특히 간 후부 하대정맥의 손상은 사망률이 대개 75% 이상이며, 이는 시야확보와 지혈 등의 수술적 어려움에 기인한다. 하대정맥 손상 환자의 생존은 손상의 심한 정도와 해부학적 접근가능성 등과 연관이 있다. 총상에 의한 간 후부 하대정맥 손상환자의 수술을 경험하였기에 문헌 고찰과 함께 보고한다.

• 대한정형외과 초음파학회지
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• 제4권1호
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• pp.20-23
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• 2011

관통성 손상 후 외부 이물질이 신체 조직 내 남아 있는 경우는 응급실을 방문하는 주요 원인 중의 하나이다. 수부에서 발견되는 이물질은 대부분 외상에 의해 발생하며 식물성 조각들이 가장 흔하고, 다음으로 유리조각, 금속조각의 순서로 발생한다. 특히 나무조각이나, 플라스틱 조각 등은 방사선투과성(radiolucency)을 가지고 있어 단순 방사선 사진으로 쉽게 발견하기 어려운 경우가 많아 외부 이물질을 찾는 것이 어려울 뿐만 아니라 일부 제거하더라도 이물질의 잔존 여부를 감별하기가 어렵다. 이에 저자들은 나무가시에 수상 당한 후 1차 의료기간에서 일부 나무가시를 제거 후 잔존 나무가시를 발견하지 못하고 수상 4주 이후 초음파을 이용하여 잔존 이물질을 진단하여 수술적으로 치료 후 동통의 감소를 보인 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.115-118
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• 2007

Purpose: It is even less common traumatic pseudoaneurysm of the superficial temporal artery and rare with fewer than 200 cases reported in the recent literature. Most common causes of traumatic pseudoaneurysm is sequelae of blunt, penetrating, or iatrogenic surgical trauma. The diagnosis is based on physical findings and can be confirmed by duplex ultrasonogram, computed tomography, and angiography. Surgical resection, percutaneous embolization and conservative treatment have all been used to treat pseudoaneurysm. However recently, non invasive technique like percutaneous thrombin injection under ultrasonographic guidance has been done rather than surgical ligation. In this report, we proposed the several treatment options such as conservative treatment, thrombin injection, and surgical ligation according to the multifarous conditions of pseudoaneurysm, patient, and causes. Methods: We describe two cases of traumatic pseudoaneurysm of superficial temporal artery in which CT angiography was effective in diagnosis and characterization. One is chronic pseudoaneurysm after traffic accident, which is fusiform shape and small size. Since the patient prefered it, we proposed percutaneous thrombin injection first. But we recognize that this method failed, we used surgical ligation according to information of CT angiographic findings. The other is acute pseudoaneurysm after blunt trauma, which is large size accompanying large hematoma. So we proposed compressive dressing and aspiration of hematoma. Results: Two cases were well treated with no recurrence or complication. Conclusion: In conclusion, when selecting a treatment options, followings should be considered: pseudoaneurysm in CT angiography, chronicity, cause, and patient's preference.

• Journal of Chest Surgery
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• 제30권3호
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• pp.315-321
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• 1997

저자들은 1994년 1월부터 1995년 12월까지 비관통성 늑골골절로 인하여 도시지역에 위치한 조선대학 교 부속병원 흉부외과에 입원한 326명의 환자와,농촌지역에 위치한 전남 화순중앙병원 흉부외과에서 입원 치료 받았던 환자 102명에 대하여 임상적 차이를 서로 비교하였다. 가장 흔한 연령층은 도시지역 30∼50대, 농촌지 역 40∼60대 였고 남녀비는 전체지 역에서 남자에서 3배이상의 많은 빈도를 보였다. 비 관통성 늑골골절의 가장 흔한 원인은 양 그룹에서 교통사고가 가장 많았으며 두번째로 많은 원인은 도 시지 역은 추락사고로 355례중 66례(20.2%), 농촌지 역은 농기구 사고로 102례중 18례(17.6%)였다. 손상 부위별로는 도 · 농간. 유의한 차이없이 좌측에서 많았고 가장 흔한 늑골골절은 3번에서 6번까지의 늑골 이었다. 수상후 첫 1시간내에 내원한 경우는 도시지역이 16.0%, 농촌지역이 23.5%로 차이를 보였다. 치 료는 보존적 치료, 흉강천자술, 폐쇄성 흉관 삽관술, 개흉술 등으로 하였는데, 도시지역이 326례중 134 례(41.1%), 농촌지역of 102례중 81례(79.4%)에서 보존적 요법을 시 행하였고, 개흉술은 도시지 역이 37례 (11.3%),농촌지역이 3례 2.9%)에서 시행하여 도시지역이 농촌지역에 비하여 더 적극적인 치료방법을 선택하는것으로 나타났다. 전체 사망률은 도시지역이 4.29%(14례), 농촌지역이 1.96%(2례)였고 사망원 인은 출혈성 쇽, 뇌부종 등이었다.

• Journal of Chest Surgery
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• 제43권6호
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• pp.808-811
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• 2010

자상에 의한 기관, 식도, 척수 관통상은 발생빈도가 낮은 손상으로 점차 그 빈도는 줄어드는 추세이다. 그러나 일단 발생하면 매우 심각한 증상을 유발하여 생명의 위험을 초래하고, 많은 합병증을 야기하기 때문에 조기에 진단하여 외과적으로 치료하는 것이 가장 바람직하다. 본 저자는 60세의 남자 환자가 자신의 목에 과도로 자상을 입혀 발생한 기관 및 식도 열상, 그리고 척수 손상에 의한 하반신 마비의 치험 사례를 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.383-396
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• 2000

Before the advent of early plastic or maxillofacial reconstructive surgery, facial features could only be replaced and mimicked by prosthetic, artificial means. Facial deformity or dysfunction, whether congenital or acquired by trauma or mutilating disease, has long been an area of constant research, development and innovation in many cultures of the world. One of the greatest contributors to the need for maxillofacial prosthetics has been physical conflict and warfare. The use of maxillofacial prostheses is not merely the replacement of a missing or disfigured aspect of the face, but the rehabilitation of that individual back into the society from which they originate. Rehabilitation includes the restoration of the person's self worth and confidence, not just physically but psychologically. In sixteenth century, Ambroise Pare, French military surgeon, first have tried many maxillofacial prosthetics for injured war soldiers with papier-mache, silver, gold and copper. According to patient's demand who lost their maxillofacial figures, maxillofacial personnel have increased and prosthetic's skill have been advanced all of the world. Over the last decade, there has been a very rapid development in technical possibilities to provide patients with facial prostheses retained by skin penetrating implants. This article will present overall history of maxillofacial prostheses and some background information on the materials used from the old world. And to overcome still many limitation of prosthetic, new minds and new ideas for technique and materials should be developed.

• Journal of Korean Neurosurgical Society
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• 제45권5호
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• pp.312-314
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• 2009

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature.