• Archives of Plastic Surgery
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• v.48 no.6
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• pp.678-684
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• 2021

Background A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scarring of the wound margins. This study describes the clinical appearance of the injured areas and surgical complications that occurred during the follow-up period in a series of children with car-tire friction injuries who were treated with split-thickness skin grafts (STSGs). We describe the clinical features that we believe need to be highlighted when initially treating car-tire injuries in children. Methods From May 2003 to June 2016, our retrospective study included 15 patients with car-tire injuries on the dorsum of the foot who were treated with surgical excision and STSG to cover the wound. Results A total of 15 patients with car-tire injuries were treated. The average age was 6.26 years old. The average injury grade was 3.26. Two patients were treated using delayed repair, and 13 patients received STSG for initial management. Four patients experienced no complications, while 11 patients had hypertrophic scars and/or scar contracture after surgery. Conclusions A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scar formation or scar contracture even if proper management is undertaken. Since the occurrence of these complications in childhood can lead to a secondary deformity, it is important to properly treat car-tire friction wounds, inform patients and caregivers about potential complications, and ensure regular follow-up evaluations over a 12-month period following the initial surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.2
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• pp.224-227
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• 2000

Gunshot wounds to the face are often dramatic at the time of presentation. Although care must be individualized, protocol approach helps the clinician rapidly evaluate patient and plan treatment. Early X-ray films help to determine the precise trajectory. Rapid neurologic assessment and early CT scanning based on physical examination ot trajectory will allow for identification of even occult injuries early. Lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest and pleural space have been reported. A combination of surgical debridement and chelation therapy with oral succimer produce a satisfactory outcome. We have managed a patient with Lt facial gunshot wound and Lt mandible angle fracture by open reduction of angle fracture and surgical removal of remnant bullet and medially advanced cheek skin flap. We have obtained good result and report this case with review of literatures.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.305-310
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• 2023

Background In this modern era of science-based medicine, some people still accept folk remedies as an alternative form of medicine. However, misinformation and misuse of folk medicines can result in dangerous complications. Among the possible complications of folk remedy use, this study focused on the clinical characteristics of burns caused by folk remedies. Methods We retrospectively reviewed the clinical records of patients who had been treated for burns caused by folk remedies from May 2015 to April 2022. Data were collected on patients' age and gender, type of folk remedy, reason for using the folk remedy, the severity of the burn, the number of wounds, lesion type, and type of treatment. Results We found 59 patients with burns due to folk remedies. Most were female (76.3%) and ≥ 60 years old (72.9%). The most common type of folk remedy was moxibustion (74.6%), followed by the use of glacial acetic acid (20.3%). The reasons for using folk remedies were arthralgia relief (39%), health improvement (18.6%), and treatment of tinea pedis (11.9%). Most patients had multiple wound sites and had burns that were considered severe, requiring surgical treatment (72.9%). The majority of lesions were on the lower extremity, including the foot. Conclusion This study described the risk of burns caused by folk remedies and the clinical characteristics of the wounds. The results emphasize the need for greater public awareness of the risk of burn injuries when using folk remedies.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.87-91
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• 2024

Gunshot-induced chest trauma is exceedingly rare among civilians in South Korea due to strong firearm control policies. In contrast to military reports emphasizing the use of emergent open thoracotomy to increase chances of survival, most penetrating non-cardiac injuries in civilian settings are managed conservatively, such as through chest tube insertion, as they typically result from lower-energy bullets. However, early surgical intervention for penetrating gunshot wounds can help reduce delayed fatalities caused by septic complications from pneumonia or empyema. The advent of minimally invasive thoracic surgery has provided cost-effective and relatively non-invasive treatment options, aided in the prevention of potential complications from undrained hematomas, and facilitated functional recovery and reintegration into society. We successfully treated a patient with a penetrating gunshot wound to the chest using video-assisted thoracoscopic surgery.

• Korean Journal of Bronchoesophagology
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• v.16 no.2
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• pp.121-125
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• 2010

Background: Penetrating neck injuries are potentially dangerous and require emergency management because of the presence of vital structures in the neck. The risk of airway, vascular, neurological, and pharyngoesophageal injuries leads to many difficult diagnostic decisions. The purpose of this retrospective study is to evaluate our experience with management of penetrating neck injuries, and to assess treatment outcome. Material and Method: Forty-two consecutive patients were identified (26 patients from Korea university Ansan hospital, 16 patients from Guro hospital) as having penetrating neck injuries from 2003 to 2009. With review of medical records, variables were collected and evaluated including the location of injury, mechanism of injury, number of significant injuries, diagnostic modalities, duration of hospital stay and outcome. Results: The location of injury was zone I (lower neck) in 13 cases (31%), zone II (midportion of the neck) in 22 (52%), and zone III (upper neck) in 7 (17%). Injuries were caused by stab wounds in 23 patients, penetrating foreign bodies in 12. Among 35 patients who had deep injuries that violated the platysma, significant injuries, including major vascular (20), trachea (5) Pharyngoesophageal injuries (5) were identified in 24 patients. The mean hospital stay was 9.5 days. Conclusion: The penetrating trauma in the neck may show various degrees of severity. However, Cervical penetrating injury should not be underestimated in spite of the minimal width of the lesion.

• Journal of Trauma and Injury
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• v.35 no.2
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• pp.84-91
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• 2022

Purpose: The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients. Methods: We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0-18 years), adults (19-59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections. Results: Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16-48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279-12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488-10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167-10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221-5.475; P=0.013). Conclusions: When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.

• Journal of Chest Surgery
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• v.44 no.5
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• pp.348-354
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• 2011

Background: Traumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm. Materials and Methods: The subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated. Results: Causes of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was $47.80{\pm}56.72$ days, and the period of ventilation was $3.90{\pm}5.8$ days. The average ISS was $35.90{\pm}16.81$ (11~75), and the average RTS was $6.46{\pm}1.88$ (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS. Conclusion: There are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuries, there are a great number of complications. Significant factors affecting the complication rate were stomach hernia and age. ISS and RTS were significant as factors affecting the mortality rate. In the case of severe trauma such as pelvic fractures, frequent physical examinations and chest X-rays are necessary to confirm traumatic rupture of the diaphragm because it does not have specific symptoms, and there are no clear diagnosis methods. Complications and the mortality rate should be reduced with early diagnosis and with treatment by confirming diaphragmatic rupture in the thoracic cavity and the abdomen during surgery.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.376-384
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• 2023

Purpose: The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity. Methods: In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients' mode of transport. Results: This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder. Conclusions: This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.291-296
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• 2022

The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

• Journal of Trauma and Injury
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• v.25 no.2
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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.