• Journal of Chest Surgery
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• 제50권5호
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• pp.399-402
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• 2017

We report the case of a patient with penetrating chest trauma (right chest) who had undergone a left pneumonectomy due to pulmonary tuberculosis 24 years ago. We performed an emergent thoracotomy, finding an opening of the penetrating wound in a lower-lobe basal segment of the right lung. A stapled tractotomy was performed along the tract. Bleeding control and air-leakage control was done easily and rapidly. The patient was discharged without any complications on the seventh day of admission. Tractotomy can be a good option for treating penetrating lung injuries in patients with limited lung function who need emergent surgery.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.47-51
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• 2007

Penetrating chest trauma caused by the components of one's own car is rare in motor vehicle accidents. We experienced two cases of penetrating chest injury caused by the sideview mirror of the patient's vehicle. One was a 25-year-old man. The sideview mirror penetrated the left chest, went through the diaphragm, and ruptured the spleen. He was in shock upon arrival at the emergency room. An emergency thoracotomy and laparotomy were done. The ruptured spleen was resected, the lung and the diaphragm were debrided and repaired, and the chest wall was reconstructed. The other patient was a 57-year-old male, who was transported to our emergency room with the sideview mirror of his truck stuck into his right chest wall as the result of an accident. He also had a right Bennet's fracture and an open fracture of the right tibia. Air had been sucked into the right pleural cavity through the wound. Multiple rib fractures and lung lacerations had also occurred. Removal of the sideview mirror, repair of the lacerated lung, and reconstruction of chest wall were done immediately. Both patients recovered without complication and were discharged.

• Journal of Chest Surgery
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• 제7권1호
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• pp.23-30
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• 1974

During the 35 month period from November 1966 to November 1967 and from June 1971 to March 1973 I had experienced 127 cases of non fatal wounds of chest in Viet-Nam. .Among these 127 cases, 62[45.4%] were gun shot wounds, 49[35.8%] were shrapnel wounds and the other were traffic accident. stab wounds and miscellanous. Approximately 21% of gun shot wound were perforating and 79% were penetrating but all cases of shrapnel wounds were penetrating. Of these 127 cases. 90% evacuated to hospital within 6 hours and average time 2.5 hours. The tranfusion requirement of these cases ranged from zero to 36 pints of whole blood with an average of 2.600cc. Initial intrathoracic findings were hemopneumothorax and hemothorax mostly. and the incidence of open thoracotomy was 9.5%[12cases] and closed thoracotomy was 82.8%[104cases], which were contrast to the reports from Korean conflict. I had experienced 24 cases with complication, such as large hematoma in lung parenchyme[8 cases], atelectasis[4 cases], pyothorax [3 cases], pneumonia [3 cases], fibrothorax [3 cases], pleural effusion [2 cases] and wound infection [2 cases]. Mortality rate for entire group was 4.7% but the cases associated with brain injury was 100%, with spinal cord injury was 50%, with large vessel 50%, and abdominal injury was 33.3%, and nobody died solely of thoracic injury.

• 대한기관식도과학회지
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• 제13권2호
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• pp.57-60
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• 2007

The management of penetrating zone II neck injuries without hard signs of vascular injury has been controversial. The controversy lies between mandatory exploration and a selective approach to the management of theses injuries. Authors that advocate mandatory exploration state its low complication rate and high sensitivity in support of this approach. Surgeons in support of selective management argue selective management has comparable efficacy with lower morbidity in comparison with mandatory exploration. Recently we experienced a case of stab wound near vertebral artery and operatively explored, therefore we report a case along with review of literature.

• Journal of Chest Surgery
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• 제20권1호
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• pp.101-105
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• 1987

A clinical evaluation was performed on 17 cases of the cardiac and great vessel injuries above the subclavian vessel at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital from April, 1980 to September, 1986. The results were as follows: 1. Sex distribution were 13 cases in male and 4 cases in female. In age range, second and third decades occupied in about 65% of total cases. 2. Modes of injury were penetrating wound is 14 cases and nonpenetrating wound in 3 cases. The stab wounds by knife were most frequent. 3. Time interval from injury to operation was mean 103 minutes. 4. Surgical approaches were performed with thoracotomy in 9 cases, median sternotomy in 3 cases and direct incision above the wound. 5. Sites of injury were heart in 10 cases and great vessel in 7 cases. The right ventricular injury was most common as 7 cases. 6. Operative procedures were performed with simple closure, vascular graft anastomosis and ligation. There was no postoperative death.

• Journal of Chest Surgery
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• 제23권5호
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• pp.929-935
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• 1990

Violence in our society, combined with improving transport system, resulted in increased numbers of patients with cardiac wounds reaching the hospital alive. Most patients with penetrating cardiac injury, rather than blunt injury, present with a syndrome of either hemorrhagic shock or cardiac tamponade. And they should be operated upon as soon as possible. Often the atrioventricular valves and other important cardiac structures are also damaged by the penetrating instruments or missile. Both intracardiac communications and atrioventricular fistulas may result in significant left-to-right shunts accompanied by congestive heart failure, necessitating surgical correction. Usually, retained cardiac foreign bodies, which are almost always bullets or fragments of missiles, may lie within a cardiac chamber or in the myocardium. Emboli of bullets or other missiles from distant sites to the right side of the heart are numerous enough to require attention. Recently we experienced a case with intracardiac foreign body due to penetrating cardiac injury. A 19 year-old man was admitted to our hospital due to penetrating anterior chest wound by iron segment. The roentgenogram of the chest revealed a radio-opaque metallic shadow in left lower chest around the cardiac apex, mild blunting of left costophrenic space, but no cardiomegaly. During operation the foreign body was noted to be present in the cardiac chamber by the portable C-arm fluoroscopy. But during the manipulation it moved into left inferior pulmonary vein from left ventricle by way of left atrium. So we could manage to remove it from left inferior pulmonary vein by direct approach to the vein. It was iron segment, sized 0.lcm x0.6cmx0.5cm, with sharp margins. The patient had an uneventful postoperative recovery except for chylopericardium and was discharged.

• Journal of Chest Surgery
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• 제21권3호
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• pp.471-478
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• 1988

We evaluated forty cases of traumatic diaphragmatic injuries that we have experienced from Jan. 1972 to Dec. 1987. 28 patients were male and 12 were female[M:F=2.3:1]. The age distribution was ranged from 4 to 71 years with mean age of 26. The diaphragmatic injuries were due to blunt trauma in 27 cases[traffic accident 22, fall down 3, others 2] and penetrating trauma in 13 cases[stab wound 11, gun shot 1, other 1]. In the blunt injury,14 cases of 17 were diagnosed and treated within 24 hours in the left diaphragmatic injury but only 3 cases of 7 cases in the right diaphragmatic injury were diagnosed and treated within 24 hours. All cases except one in penetrating injury were diagnosed and treated within 12 hours. In the blunt injury, the rupture site was located in the left in \ulcorner7 cases and in the right in 7 cases. In the penetrating injury, the rupture site was located in the left in 11 cases and in the right in 2 cases. The repair of 37 cases were performed with thoracic approach in 20 cases, thoracoabdominal approach in 12 cases and abdominal approach in 5 cases. Over all mortality was 17.5%[7/40] and postoperative mortality was 11%[4/37]. The causes of death were hypovolemic shock[3], combined head injury[2], acute renal failure[1] and septic shock with ARDS[1].

• Journal of Chest Surgery
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• 제7권1호
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• pp.13-22
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• 1974

A clinical evaluation was done on 120 cases of chest injury patients treated in the department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital for the period of 6 years and 3 months from January, 1968 to March, 1974. 1] Of 120 cases, 52 cases[43. 3%] were non-penetrating injuries and 65 cases[56.7%] penetrating injuries. Of them, 107 cases [89.2%] were males and 13 cases[10.8%] were females. 2] The most common etiology was stab wound[64 cases] and traffic accident[23 cases] was the next. 3] In 70% of all cases, treatment was initiated within 6 hours after receiving trauma. 4] The types of lesions in order of frequency were hemothorax[35 cases], chest wall injuries alone. 27 cases], hemopneumothorax [22 cases], pneumothorax[17 cases]. Of them, right sided lesions were 52 cases[43. 3%] and left sided lesions were 65 cases[54.2%] and 3 cases were bilateral lesions. 5] Repeated thoracentesis and closed thoracostomy were the treatment of choice in most cases in order to reestablish early and rapid reexpansion of the lungs. Open thoracotomy was, however, mandatory on 39 cases[32.5%]. 6] The overall mortality was 5.8% [7 cases]; 5 cases of nonpenetrating injuries and 2 cases of penetrating ones.

• 한국응급구조학회지
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• 제9권1호
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• pp.95-99
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• 2005

Penetrating neck trauma by gunshot injury involving tracheobronchial tree is rare in Korea. Extensive tissue damage by cavitation, tissue fragmentation and shock wave transmission of high-velocity projectile along with associated organ injury renders high rate of mortality and morbidity. A 28 year old man in military service with gunshot wound in left cervical area presented initial symptoms of severe dyspnea and subcutaneous emphysema. Computed tomography of chest and cervical region as well as bronchoscopic evaluation was performed to confirm highly suspected injury to cervical trachea. Surgical exposure was established through a low collar incision; the damaged segment of 3.5 cm length including 2-4th tracheal rings was resected out and end-to-end anastomosis was performed. Bleeding from lacerated anterior jugular vein was controlled by ligation of both ends and a K2 bulllet was found upon inner border of body of first rib, medial to right carotid sheath and removed out. Cervical esophagus, carotid artery, internal jugular vein and recurrent laryngeal nerve were spared. Extubation was done on the first postoperative day and postoperative course until discharge on nineth postoperative day remained uneventful.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.253-257
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• 2023

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.