• Journal of Trauma and Injury
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• v.37 no.2
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• pp.147-150
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• 2024

This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.

• Journal of Trauma and Injury
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• v.35 no.2
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• pp.118-122
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• 2022

The usual cause of penetrating thoracoabdominal injuries with evisceration are stab wounds with knives and other sharp weapons used during fights and conflicts. Evisceration of the abdominal viscera as a result of trauma, with its attendant morbidity and mortality, requires early intervention. Gunshot wounds can also cause penetrating thoracoabdominal injuries. We report the case of a 52-year-old male patient, a worker at a timber-processing factory, who was assaulted with a chainsaw by his colleague following a disagreement. He was seen at the accident and emergency department of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with a thoracoabdominal injury about 1.5 hours after the attack. He had a left thoracoabdominal laceration with abdominal evisceration and an open left pneumothorax. He was managed operatively, made a full recovery, and was discharged 16 days after admission. He was readmitted 4 months after the initial surgery with acute intestinal obstruction secondary to adhesions. He underwent exploratory laparotomy and adhesiolysis. He made an uneventful recovery and was discharged on the 9th postoperative day for subsequent follow-up.

• Journal of Trauma and Injury
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• v.32 no.4
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• pp.210-219
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• 2019

Purpose: Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury. Methods: We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury. Results: In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity. Conclusions: Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients' prognosis. Multi-center, prospective studies are needed in the future.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.382-385
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• 1990

In recent era, the incidence of combined injury of cervical trachea and esophagus by penetrating wound has been increased considerably. If initial operative repair is unsatisfied, devastating complications and even death may be considered. A 5 years old boy and 67 years old female were admitted to our department for deep cervical stab wounds. On exploration, cervical trachea and esophagus was nearly total transected anteroposteriorly. Emergent reconstructive surgery for trachea and esophagus had done. Postoperative course was uneventful without any complications.

• Journal of Trauma and Injury
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• v.21 no.2
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• pp.136-139
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• 2008

A great variety of penetrating injuries is happening due to the increasing population and violence today. An optimal surgical approach is the key factor for successful repair of a complicated penetrating injury. A 23-year-old woman fell down the stairs from the second floor and received cervico-thoracic penetration injury due to a metalic bar. The metalic bar ruptured the right jugular vein and penetrated the left upper and lower lung. Under cervico-median sternotomy, neck vessels were repaired and the left thorax was successfully entered to repair the damaged lung through the mediastinal pleura. With this approach, the patient's position did not need to be changed during operation, while reduced the operation time compared to the conventional approach (cervical incision and standard thoracotomy).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.5
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• pp.447-451
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• 2001

With the exception of gun shot wound, the incidence of penetrating injury of face and neck areas nonorganic foreign bodies is relative low. But the diagnostic evaluation and therapeutic management of penetrating facial wounds need careful decision, when the anatomic proximity of the major vessels and nerve is considered. Penetrating facial trauma with concomitant vascular injury present challenging problems, the immediate complication of this vascular injury are severe bleeding, hematoma formation, shock, obstruction of airway. The vascular injury is conformed by angiography. In this report, a industrial tool(long tack) fired by explosive air is penetrated into face and to neck. In angiograms penetrating injury of the vertebral artery is detected. We performed the embolization of the vertebral artery with coils and manual removal of the foreign body without any complication was followed.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.698-704
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• 1989

We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.82-86
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• 2018

Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.

• Archives of Craniofacial Surgery
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• v.24 no.1
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• pp.37-40
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• 2023

Penetrating wounds to the face are cosmetically devastating and can be life-threatening. If the foreign body causing the penetrating wound is a piece of wood, small remnants might be left behind after the initial treatment. A 33-year-old male patient presented to the emergency center after a piece of lumber pierced his face as a passenger in a traffic accident. The patient's vital signs were stable, and emergency surgery was performed to remove the foreign body and repair the soft tissue. No noteworthy complications were seen after open reduction and internal fixation of the facial bone fractures. Seven months after the accident, the patient underwent scar revision along with full-thickness skin grafting for post-traumatic scars. After the surgery, pus-like discharge which was not previously present was observed, and the graft did not take well. A residual foreign body, which was the cause of graft failure, was found on computed tomography and the remaining foreign body was removed through revision surgery. The patient is receiving outpatient follow-up without any complications 6 months after surgery. This case demonstrates the importance of performing a careful evaluation to avoid missing a residual foreign body, especially if it is of wooden nature.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.295-297
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• 2023

Penetrating gallbladder injuries are uncommon in the pediatric population. The treatment varies according to the severity of the injury and the patient's hemodynamics. We present the case of an 11-year-old male with an accidental pellet gunshot wound to the right upper abdomen that resulted in a grade III liver laceration and damage to the anterior gallbladder wall. The patient underwent laparoscopic cholecystectomy with drain placement. Postoperative radiography of the surgical specimen confirmed the presence of the pellet in the gallbladder. The patient recovered uneventfully and was discharged home on postoperative day 3. Laparoscopic cholecystectomy is a feasible treatment option for penetrating gallbladder injuries in hemodynamically stable patients.