• Archives of Plastic Surgery
• /
• 제38권6호
• /
• pp.761-764
• /
• 2011

Purpose: Pediatric facial laceration takes a huge part of patients visiting emergency room and generates social attention for its proper emergency care. So much more attention should be paid to the proper treatment at emergency care unit, and furthermore, thorough survey of background information of the pediatric facial laceration may offer more proper prevention. Methods: According to annual reports of 2009 and 2010, out of 5149 facial laceration patients who were given primary medical care at our clinic, 1452 patients were aged under 15 years old. Retrospective analysis of each pediatric facial lacerations were evaluated according to gender, age, periodic table, cause of injury, place of injury, sites of injury and so on. Results: Pediatric facial laceration was found to occur mostly at 1 year old as they learn to walk and explore their environment. Evaluated analysis revealed that pediatric facial accidents occurred mostly on forehead region (75%), on Sundays, from 5 p.m. to 8 p.m., at home (61.5%). Most common cause of injury was collision (54.5%). Conclusion: In large group of pediatric facial laceration cases provided us with an surprising fact that accidents most commonly occur under parental supervision. This fact gives an actual understanding regarding pediatric facial laceration and more realistic approach in its prevention strategy.

• Archives of Plastic Surgery
• /
• 제37권2호
• /
• pp.199-201
• /
• 2010

Purpose: Except for continuous suture in skin layer, stitching out in facial laceration, we have to hold each knots up and cut the knots by No. 11 blade or small scissors. However, we often have difficulty in stitching out the knots on children who do not cooperate well. Therefore we introduce an easy and fast stitch out method of pediatric lacerations. Methods: From January to May 2009, we studied 15 pediatric patients (mean age 5.6 years old) who had facial laceration on face or underwent any surgery on operation room. For easy stitch out, we left the one string of the first knot long enough to extend at the opposite end of laceration site. And then the extended string was fixed to skin using Steri-strip. Next we do simple interrupted suture including the extended traction nylon string inside the knot. Through this method, we can stitch out all knots simply by lifting up the traction nylon needless to hold the each knot one by one. Results: Until stitching out, the traction nylon was just right position and there was no normal tissue injury during stitch out all knots. Patients were satisfied with the short stitch out time. Conclusion: By using the traction nylon on pediatric laceration suture, we can stitch out all the knots with no normal tissue injury in less time.

• Archives of Plastic Surgery
• /
• 제36권1호
• /
• pp.122-125
• /
• 2009

Purpose: Stitching out in facial simple laceration on children, we use No.11 blade. But the procedure is technically demanded to take care of the uncooperative pediatric patient. When we suture a laceration on the pediatric patient, we apply this method using ribbon shaped knot. On stitching out, We pull one the edge of a stitching fiber easily without injury about normal tissue. Methods: We studied 54 pediatric patients who have facial lacerations for children under six years old, from May, 2006 to December, 2007 in Plastic Surgery department, emergency room. Among them 35 were male, 19 were female and age average was 3.9. Results: For following up dressing, ribbon shaped knot did not get loose. After stitching out in facial laceration on children, Major complication of infection, hematoma, dehiscence was not found. Conclusion: The advantage of this operation method using ribbon shaped knot when we Stitch out the fiber on the incorporative pediatric patients, is easy to perform and to reduce the stitching time, without sedation.

• 대한소아치과학회지
• /
• 제29권3호
• /
• pp.450-454
• /
• 2002

연구개 및 구인두부의 열창은 아동들에게 상대적으로 흔한 편이다. 연구개 열창은 신생아부터 노년층까지 모든 연령에 걸쳐 보고된 바 있지만, 어린 아동들 특히 걸음마를 막 시작한 아동들에게서 많이 보고되었다. 이러한 아동들의 경우 입안에 물체를 물고 돌아다니다가 넘어지거나 떨어져서 구인두부 열창을 입게되는 경우가 많은 편이고, 주로 4세 정도에 호발하며, 여아보다는 남아에서 더 이러한 외상이 자주 나타나는 것으로 보고되었다. 주로 손상을 입는 연구개 및 구인두 부위는 좌측 편도 상단부위이며, 관통상없이 선상이나 표면상의 손상으로 주로 발생하고, 손상 형태는 U자 형태 혹은 V자 형태로 나타난다. 이러한 외상에 있어 관통상이나, 크게 조직편이 이개된 경우를 제외하고는 봉합술은 필요하지 않으며, 오히려 이러한 봉합술이 외상부위의 치유를 지연시킬 수 있다. 본 창상의 치유에는 3주정도 소요되며 상흔은 거의 남지 않는 것으로 보고되었다. 그러나 연구개의 창상이 경동맥의 손상을 야기하여 신경학적인 합병증이 발생했다는 보고가 있으므로, 2-3일간은 외상을 입은 환아에 대한 주기적인 관찰이 필요하며, 합병증 발생시 구강외과의 및 이비인후과의 또는 신경외과의와의 협의진료가 필요하다. 본 증례는 2세 및 3세 남환아로 입안에 이물질을 물고 넘어져 연구개의 열창을 입은 경우로 비외과적인 처치 및 신경학적인 평가 후 완치되어 이에 보고하는 바이다.

• Journal of Trauma and Injury
• /
• 제22권1호
• /
• pp.103-107
• /
• 2009

Purpose: There are no reports on amusement-park-related injuries in Korea. Thus, the objective of this study was to describe traumatic injury patterns that occurring in an amusement park. Methods: The medical records of an infirmary were retrospectively reviewed. From January 1, 2008, to December 31 2008, patients who were transferred to the nearest emergency departments of hospitals for the purpose of further test and treatment were enrolled. Demographics, injury types and involved parts of the body were analyzed. Results: A total of 3,608 patients visited an infirmary for traumatic injury and about two-thirds had soft issue injuries. Of those, 191 patients (5.3%) were transferred to the emergency department of a hospital. Of the patients who were transferred to a hospital, laceration and contusion were the responsible injuries for about half. Laceration was the most common injury in pediatric patients, and a sprain or a strain was the most common in adult patients. The most commonly injured parts of the body were the extremities in adult patients. However, in pediatric patients, injuries of the head, face and neck were similar to injuries of the extremities. Conclusion: Soft tissue injury was the most common amusement-park-related injury. Laceration was the most common reason to transfer a patient to a hospital. There were differences in injury type and injured part of the body between adult and pediatric patients.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.178-185
• /
• 2014

Purpose: The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED). Methods: Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded. Results: A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups. Conclusion: In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.

• Journal of Trauma and Injury
• /
• 제36권3호
• /
• pp.295-297
• /
• 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.

• Archives of Plastic Surgery
• /
• 제41권1호
• /
• pp.40-44
• /
• 2014

Background Chloral hydrate (CH) is the primary agent most commonly used for pediatric sedation prior to diagnostic, therapeutic procedures. In the management of pediatric facial laceration, the initial dose of CH has to balance the need for adequate sedation against the need to minimize sedative complications. Methods A retrospective review of medical records of 834 children who visited our emergency room for facial lacerations from August 2010 to September 2012 was conducted. They were divided into six groups on the basis of the initial dose of CH administered. Further, each group was compared with the standard group (70 to ${\leq}80mg/kg$) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay. Results With respect to the complication rate, only group 1 (range, 40 to ${\leq}50mg/kg$) showed a significantly lower complication rate. In the case of all the other variables considered, there were no significant differences among any of the groups. Conclusions An initial CH dose of $48{\pm}2mg/kg$ does not negatively affect the success rate of sedation or the need for additional sedative during the primary closure of facial lacerations in pediatric patients. Further, lower doses reduce the incidences of adverse effects and do not delay procedure readiness. Therefore, $48{\pm}2mg/kg$ of CH can be considered the optimal initial dose for pediatric sedation.

• Archives of Plastic Surgery
• /
• 제50권1호
• /
• pp.30-36
• /
• 2023

Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.

• 대한두개안면성형외과학회지
• /
• 제22권2호
• /
• pp.119-121
• /
• 2021

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.