• Journal of Chest Surgery
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• 제18권1호
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• pp.111-121
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• 1985

A clinical analysis was performed on 312 cases of the chest trauma experienced at department of thoracic surgery, Chosun University Hospital during the past 6 years 10 months period from January 1978 to October 1984. 1. The ratio of male to female patient of the chest trauma was 3.1:1 in male predominance and age from 20 to 50 occupied 71.2% of the total cases. 2. The most common cause of the chest trauma was traffic accidents [45.5%] in this series. 244 cases [78.2%]were injured due to non-penetrating injuries and the remainders [68 cases, 21.8%] were injured due to penetrating injuries. 3. The frequently injured site of the chest trauma was left side of the chest [56.4%], the right side was 33% and the both side was 10.6%. 4. The most common symptoms were chest pain and dyspnea, and common signs were diminished breathing sound and subcutaneous emphysema. 5. The Hemothorax, Pneumothorax, Hemopneumothorax, and Hemopericardium were observed in 190 cases [60.9%] of the total cases, and etiologic distribution revealed 76.5% due to penetrating injuries and 56.6% due to non-penetrating injuries. 6. The rib fractures were observed in 210 cases [67.3%] of the total cases and the most common site of the rib fracture was 6th rib 140 cases [19.2%]. The common site of the rib fracture was from 4th rib to 7th rib [63.8%]. 7. The lung injuries were observed in 150 cases [48.1%] and the other organ injuries were observed in 260 cases [83.3%]. 8. Conservative treatment including thoracentesis were performed in 153 cases [49.1%], Closed thoracotomy with water seal drainage were performed in 112 cases [35.9%], and open thoracotomy were performed in 45 cases [14.4%]. 9. The complications of the chest trauma were developed in 63 cases [20.2%] and the common complications were atelectasis, wound infection and pneumonitis etc. 10. Overall mortality was 0.96% [3 cases] and the cause of death was bacteremia, hypovolemic shock, heart failure and pulmonary edema.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.49-52
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• 2010

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

• Journal of Chest Surgery
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• 제22권2호
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• pp.290-296
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• 1989

• Journal of Chest Surgery
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• 제50권5호
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• pp.391-394
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• 2017

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

• Journal of Chest Surgery
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• 제40권12호
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• pp.831-836
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• 2007

배경: 심장 손상은 외상으로 사망한 환자에서 가장 많이 간과되는 손상이다. 둔상이나 관통상으로 생존하는 환자는 드물며 그리고 발생률은 아직 명확하지가 않다. 많은 수의 환자에서 긴급 또는 응급수술을 요하며 또한 사망률이 매우 높다. 대상 및 방법: 1997년 2월부터 2005년 12월까지 흉부외상으로 심장손상을 입은 응급 흉부 절개술을 한 26명의 환자를 후향적으로 조사하였다. 결과: 남자가 17명, 여자가 9명이고 평균나이는 $45.3{\pm}16.2$세($17{\sim}80$세)였다. 13명(50%) 환자는 자동차 사고, 5명(19%)의 환자는 오토바이사고로 손상을 입었다. 6명(23%)의 환자는 칼에 의해, 2명(8%)의 환자는 작업 중 높은 곳에서 떨어져서 손상을 받았다. 손상 받은 심장은 우심방 12예(46%), 좌심방 1예(4%), 우심실 5예(19%), 좌심실5예(19%) 그리고 두 곳의 심장손상이 2예(7%)였다. 진단은 12예의 환자에서는 컴퓨터 단층촬영으로, 14예의 환자는 초음파를 이용하여 진단하였다. 입원에서 수술실까지 걸린 시간은 평균$89.2{\pm}86.7$분($10{\sim}335$)이었고, 평균 진단시간은 $51.3{\pm}13.6$분(5-280)이었다. 외상인자로 개정 외상 계수, 글라스고우 혼수 계수의 평균이 $6.7{\pm}0.8,\;12.8{\pm}2.8$이었다. 사망률은 12%였다. 결론: 심장손상으로 인한 사망률은 매우 높다. 높은 관심과, 적극적이고 신속한 진단, 그리고 즉각적이고 적절한 외과적인 치료가 환자의 생존율 높일 수 있다.

• Journal of Chest Surgery
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• 제13권3호
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• pp.269-273
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• 1980

The rupture of the aorta commonly follows major blunt trauma to the thorax. It has markedly increased in recent years, paralleling the rising number of vehicular accidents. The most frequent site of rupture is the area of the isthmus, with the ascending aorta second. The diagnosis of the condition from clinical data is difficult, and aortography is used whenever aortic tear is suspected. We are presenting a case of patient who had intimal tearing of the thoracic aorta with multiple injuries. The patient underwent surgical repair 28 days after injury with left heart [LA-Femoral artery] bypass.

• Journal of Chest Surgery
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• 제47권6호
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• pp.563-565
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• 2014

Outpatient drainage therapy is generally indicated for spontaneous pneumothoraces. A 63-year-old man, who had been attacked by a bull sustaining injuries on the right side of his chest, was referred to the emergency room with dyspnea. His chest X-ray showed a small pneumothorax. The next day, a chest X-ray demonstrated that his pneumothorax had worsened, although no hemothorax was identified. Outpatient drainage therapy with a thoracic vent was initiated. The air leak stopped on the third day and the thoracic vent was removed on the sixth day. Thoracic vents can be a useful modality for treating traumatic pneumothorax without hemothorax.

• Journal of Chest Surgery
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• 제31권8호
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• pp.804-810
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• 1998

배경: 다발성 외상환자는 교통사고, 산업재해, 우발적사고, 폭력 등의 증가로 최근 증가 추세에 있다. 다발성 외상은 심장, 폐, 대혈관 등의 흉부외상을 포함하는 경우가 많으며 이때는 환자의 생명을 위협할 수 있으므로 적절한 진단과 치료가 필요하다. 대부분의 흉부외상은 보존적 치료와 흉관 삽관술과 같은 간단한 외과적 시술 만으로 만족할 만한 치료효과를 보이지만 적절한 시기에 개흉술을 시행함으로써 환자의 생명을 구할 수 있는 경우가 있어 그 적응증 이나 시기의 판단에 있어서 경험있는 흉부외과 의사의 역할이 필요하다. 대상 및 방법: 저자는 다발성 외상 후 흉부개흉술이 필요했던 70례에 대하여 분석하였다. 환자들의 평균 나이는 35.6세 남녀비는 3.4:1이었다. 손상의 기전은 주로 교통사고, 추락사고, 자상이었다. 결과: 흉부손상의 가장 일반적인 유형은 혈흉이며, 두 번째는 횡격막 파열이었다. 환자의 60%에서 골절을 동반 하고 42.9%에서 복부손상을 37.1%에서 두부손상을 동반하고 있었다. 개흉술을 시행한 이유로는 출혈교정 혹은 지혈이 48.6%, 횡격막손상의 복구가 35.7%였으며, 폐 열상 봉합이 25.7% 였으며, 흉부 손상으로 인한 수술외에도 비장적출술(14.3%), 간엽절제술(8.6%) 간 열상 복구(5.7%)를 시행하였다. 수술후 합병증으로는 무기폐(8.6%), 창상감염(8.6%), 폐렴(4.3%)이었다. 수술후 6명의 환자가 사망하였고 수술사망율은 8.6%였다. 사망의 원인으로는 호흡부전증(2례), 급성 신기능부전증(2례), 패혈증(1례), 저혈량성 쇽(1례)이었다.

• Journal of Chest Surgery
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• 제8권1호
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• pp.37-44
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• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.

• Journal of Chest Surgery
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• 제56권6호
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• pp.456-459
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• 2023

Penetrating chest trauma may result in significant intracardiac injury. A traumatic ventricular septal defect is a rare complication that requires surgical management, particularly if heart failure ensues. We report a case of delayed repair of an outlet-type ventricular septal defect and perforation of the aortic and pulmonary valve leaflets following a stab wound. This report highlights diagnostic and surgical considerations and also presents an opportunity to review the conotruncal anatomy, which may be relatively unfamiliar to many adult cardiac surgeons.