• Journal of Trauma and Injury
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• 제36권4호
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• pp.385-392
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• 2023

Purpose: This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. Methods: A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Results: Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. Conclusions: DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

• 대한영상의학회지
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• 제81권4호
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• pp.953-957
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• 2020

저자들은 복부 대동맥에 발생한 동맥-요관루를 혈관 내 접근을 통해 성공적으로 치료할 수 있었던 드문 증례를 보고하는 바이다. 동맥-요관루는 극히 드물지만, 사망률이 7~23%에 이르는 치명적인 질환이다. 저혈량쇼크와 같은 치명적 합병증을 예방하기 위해서는 조기 진단과 함께 즉각적인 치료가 필수적이다. 하지만 질환 자체가 희귀하고 민감도가 높은 검사 방법이 없기 때문에, 진단을 위해서는 높은 수준의 임상적 의심이 반드시 필요하다. 복강 내 수술, 방사선 치료 및 요관 스텐트의 장기 설치 등의 특징적인 과거력을 가진 환자에서 외상적 사건이 동맥-요관루 발생의 촉발 요인이 될 수 있다. 복부 대동맥에 발생한 동맥-요관루 환자에서도 혈관 내 인조혈관 스텐트의 삽입은 효과적인 치료 방법이다.

• 대한영상의학회지
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• 제84권4호
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• pp.835-845
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• 2023

골반 외상은 대부분 고에너지 손상을 동반하며, 이에 따른 치명률 및 사망률이 높은 편이다. 관련된 출혈은 대부분 골반내 정맥이 손상되거나 해면골이 골절되어 발생하고 혈종에 의해 안정화되지만, 10%-20%에서 동맥 출혈이 동반되며, 골반 용적이 증가된 상태에서 동맥 출혈이 지속된다면 이로 인한 사망률은 36%-54%까지 증가한다. 골반의 해부학적 구조상 다양하고 풍부한 혈관이 분포되어 있고, 골반 외상 환자 대부분이 많은 양의 혈종을 동반하기 때문에, 수술적 치료는 시야 확보의 어려움과 눌림 효과에 따른 지혈효과를 없애 출혈을 더 조장할 수 있어, 1차적으로 인터벤션 치료가 권고되고 있다. 또한 출혈의 위치가 대부분 골절된 부분이기 때문에 CT를 통해 시술 전 출혈 부위를 특정하여 빠른 시간 내에 출혈에 대한 색전술을 시행할 수 있다. 이처럼 올바른 진단과 치료를 동시에 할 수 있다는 장점으로 인해 골반 외상 환자에 있어 인터벤션 치료는 중추적인 역할을 담당하고 있다. 본 연구에서는 문헌고찰을 통해 골반 외상에 대한 올바른 진단 및 인터벤션 치료의 유용성과 고려 사항에 대해 알아보고자 한다.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.105-110
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• 2011

Purpose: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). Methods: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. Results: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. Conclusion: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.24-31
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• 1994

저자들은 1980년 1월부터 1993년 5월까지 종골부위의 피부결손이나 또는 골결손을 동반한 연부조직 손상이 있었던 총 22례 환자에 대하여 유리피판술 또는 생골및 생피부편 이식술을 시행하고 최저 1년 이상 추시하여 다음과 다음과 같은 결과를 얻었다. 1. 유리 피부편의 크기는 최저 $7cm{\times}6cm$에서 최대 $28cm{\times}10cm$로 평균 $12.1cm{\times}9.2cm$였고, 유리 골편의 크기는 각각 $4cm{\times}3cm$, $5cm{\times}4cm$였다. 2. 재건술에 이용된 방법으로 유리 피부피판술은 족배 비판 11례, 서혜부 피판 2례, 전완부 피판 2례였고, 유리 피부근피판술은 활배근 피부근피판 3례, 대퇴근막장근 피부근피판 2례였으며, 골결손을 동반한 연부조직 손상인 경우 2례에서 생장골 피부편을 이식하였다. 3. 총 22례중 19례에서 유리편이 생존하여 86.4%의 성공율을 보였으며, 수술후 혈전증 2례와 감염이 발생하였던 1례에서 실패하였다. 이상의 결과로 볼 때, 고식적인 방법으로 치료하기 어려운 발뒤꿈치의 연부조직 또는 골결손의 치료로서 미세수술을 이용한 유리편 재건술이 유용한 방법으로 사료되며, 발뒤꿈치의 감각신경 회복에 대하여는 향후 지속적인 연구가 필요한 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제50권1호
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• pp.122-126
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• 2001

저자들은 신경섬유종증 환자에서 우측 내유동맥에 생긴 가성동맥류의 파열로 인한 자연 혈흉을 진단하고 혈관색전술로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제35권2호
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• pp.102-112
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• 2002

배경: 본 연구는 대동맥근부를 침범한 상행대동맥류 환자에서 composite valve graft를 이용한 대동맥근부 치 환술 결과를 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2001년 6월가지 composite valve graft를 이용한 대동맥근부 치환술 환자 56명을 대상으로 후향적으로 조사하였다. 대동맥판막 폐쇄부전은 50명(89%), Mafan증후군이 18명(32%), 그리고 이엽성 대동맥판막이 7명(12.5%)에서 동반되었다. 진단은 대동맥판륜 확장증 30명(53.6%), 대동맥 박리증 13명(23.2%), 대동맥근부를 침범한 상행대동맥류 11명(17.6%), 그리고 대동맥염이 2명(3.6%)이였다. 대동맥 파열로 인한 심낭 압전 및 심인성 쇽은 2명에서 있었으며 과거에 심장이나 상행대동맥 수술을 받은 환자는 9명(16%)이었다. 근부치환술시 사용된 수술방법button술식 51명(91%), 변형 Cabrol 술식 4명, classic Bentall 술식을 1명에서 시행하였다. 동반수술은 대동맥궁 치환술 24명(43%), 관상동맥우회술 8명(14.3%), 승모판 성형술 2명 및 재치환술 1명, 기타 7명이었다. 평균 순환정지, 체외순환및 대동맥차단 시간은 각각 21$\pm$14분(6-60분), 186$\pm$68분과 132$\pm$42분이었다. 결과: 조기 사망은 1명(1.8%)에서 있었고 술후 합병증으로는 심기능 부전이 16명(28.6%), 출혈로 인한 재수술 7명(12.5%), 심낭삼출 2명, 그리고 기타가 6명이었다. 술후 생존자 55명중 53명(96.4%)에서 평균 23.2$\pm$18.7개월(1-75개월)을 추적하였다. 만기 사망은 외상성 뇌출혈로 사망한 1명을 포함해 2명(3.8%)이었으며 대동맥근부 치환술과 관련한 만기 사망률은 1.9%였다. 한편 술후 1년과 6년 survival rate는 각각 98.1$\pm$1.9%와 93.275.1%였다. 대동맥근부 치환술과 관련한 합병증으로 재수술이 2명에서 시행되었으며(3.8%), 1년과 6년 후 재수술로부터의 freedom rate는 각각 97.872.0%와 65.3$\pm$26.7%였다. 잔여 대동맥에 대한 수술은 술전에 동반된 흉복부대동맥류의 확장으로 2명에서 흥복부대동맥류 치환술을 시행하였다.