• Journal of Trauma and Injury
• /
• v.21 no.1
• /
• pp.8-14
• /
• 2008

Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries. The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing opinions on whether an initial conservative or immediate operative intervention is the best line of action. Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral injury may be associated with serious complications, so prompt recognition of ureteral injuries is important. Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best prevention.

• Journal of Trauma and Injury
• /
• v.20 no.1
• /
• pp.1-5
• /
• 2007

Purpose: Grafting with autograft skin remains the most effective method for treating skin defects. When insufficient donor sites are present or patients are afraid of the operation, a skin graft is impossible. Cultured allogenic keratinocytes speed wound healing by providing cover and by producing growth factors and extracellular matrix protein. We report an application of cultured allogenic keratinocytes ($Kaloderm^{(R)}$, Tegoscience, Seoul, Korea) in the treatment of an acute partial thickness skin defect. Methods: From March 2005 to January 2006, 20 patients with a partial thickness skin defect were treated with cultured allogenic keratinocytes. The wound was covered with a sheet of cultured allogenic keratinocytes and ointment with $Bactigras^{(R)}$ gauze. The wound was inspected every two or three days. We regarded completion of epithelialization as wound healing. Results: The mean period between time of injury and time of $Kaloderm^{(R)}$ application was 7.5 days. The time taken from application of $Kaloderm^{(R)}$ to complete closure of the wounds was 7.2 days. Conclusion: In view of the favorable outcome, cultured allogenic keratinocytes are safe and effective biologic dressing materials for use in the treatment of open wounds.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.120-127
• /
• 2008

Purpose: Many studies on the time course of inducible nitric oxide synthase (iNOS) gene expression have been performed in the LPS (Lipopolysaccharide)-induced endotoxemic model, but there have been few experimental approaches to continuous peritonitis-induced sepsis model. We conducted this study to establish basic data for future sepsis-related research by investigating the time course of iNOS gene expression and the relationship with the production of inflammatory mediators in the early sepsis model induced by cecal ligation and puncture (CLP). Methods: Male Sprague-Dawley rats were operated on by sing the CLP method to induce of peritonitis; and then, they were sacrificed and samples of blood and lung tissues were obtained at various times (1,2,3,6,9 and 12 h after CLP). We observed the expression of iNOS mRNA from lung tissues and measured the synthesis of nitric oxide, $IL-1{\beta}$, and $TNF-{\alpha}$ from the blood. Results: iNOS mRNA began to be expressed at 3 h and was maintained untill 12 h after CLP. The nitric oxide concentration was increased significantly at 6 h, reached its peak level at 9 h, and maintained a plateau untill 12 h after CLP. $TNF-{\alpha}$ began to be detected at 3 h, increased gradually, and decreased steeply from 9 h after CLP. $IL-1{\beta}$ showed its peak level at 6 h after CLP, and tended to decrease without significance. Conclusion: We observed that the iNOS gene was expressed later in peritonitis-induced sepsis than in LPS-induced sepsis. Nitric oxide and key inflammatory mediators were also expressed later in peritonitis-induced sepsis than in LPS-induced sepsis.

• Journal of Trauma and Injury
• /
• v.27 no.3
• /
• pp.84-88
• /
• 2014

The severity of blunt hepatic injury correlates with internal organ damage. We experienced a patient, who had an extensive crushed liver injury. The patient was a 28-year-old man, who was involved in a traffic accident in which a wheel ran over his right upper abdomen. A grade V severe hepatic laceration was diagnosed with computed tomography. His vital signs were stable, so we could wait for times with conservative management. Bile leakage led to biloma and bile spillage into the peritoneal space. Selective percutaneous drainage was needed to control the several biloma. After four months of conservative management, could the patient was discharged in good condition.

• Journal of Trauma and Injury
• /
• v.27 no.3
• /
• pp.63-70
• /
• 2014

Purpose: In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients. Methods: The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule. Results: A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion. Conclusion: There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.

• Journal of Trauma and Injury
• /
• v.27 no.3
• /
• pp.57-62
• /
• 2014

Purpose: A hamate body coronal fracture is well known as a very rare fracture in the carpal bones and is also hard to diagnose in initial stage due to the bone's architecture. We report our experience in treatment of such a fracture, and we present a review of the relevant literatures. Methods: Four patients who experienced hamate body coronal fractures from October 2006 to October 2013 were enrolled in this study. One patient also had an associated Capitate fracture, and two patients had associated dislocations of the $4^{th}$ metacarpal joint. We performed open reduction and mini-screw fixation on the four patients. In addition, a K-wire was fixed for the two patients with dislocations. Results: The average follow-up period was 24.5 months after surgery, and bone union was observed at the $8^{th}$ week after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that joint motion was in the normal range without complications. Conclusion: When a patient has consistent pain on the ulnar side of the wrist, a hamate fracture should be suspected. Computer tomography is better than a simple X-ray scan for confirming the diagnosis of a hamate body coronal fracture. An open reduction and mini-screw fixation led to a good result.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.140-143
• /
• 2008

Degloving injuries result from the tangential force against the skin surface, with resultant separation of the skin and the subcutaneous tissue from the rigid underlying muscle and fascia. These injuries are associated with extensive soft tissue loss and occasionally with exposure of bone, and they require reconstructive modality for resurfacing and successful rehabilitation that considers the vascular anatomy and the timing of the operation. A 19-year-old male patient was transferred to our facility with degloving injury extending from the lower third of the right thigh to the malleolar area. The tibial bone was exposed to a size of $2{\times}3.5cm^2$ on the upper third of the lower leg at the posttraumatic third day. The exposed soft tissue was healthy, and the patient did not have any other associated disease. At the posttraumatic sixth day, one-stage resurfacing was performed with a medial gastrocnemius muscle flap transposition for the denuded bone and a split-thickness skin graft for the entire raw surface. The transposed gastrocnemius muscle attained its anatomical shape quickly, and the operating time was relatively short. No transfusion was needed. This early reconstruction prevented the accumulation of chronic granulation tissue, which leads to contracture of the wound and joint. The early correction of the gastrocnemius muscle flap transposition made early rehabilitation possible, and the patient recovered a nearly full range of motion at the injured knee joint. The leg contour was almost symmetric at one month postoperatively.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.71-77
• /
• 2008

Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale $(AIS){\geq}4$, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had $AIS{\geq}4$, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for $AIS{\geq}4$ and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.78-84
• /
• 2008

Purpose: Recently, the incidence of blast injury has been on the increase worldwide. The purpose of this study was to evaluate and analyze blast injuries in South Korea. Methods: This was a retrospective multi-center study of blast injuries in three tertiary military centers. The medical records of patients with blast injuries from January 2003 to December 2007 were reviewed. The injury severity was evaluated according to the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma Score and the Injury Severity Score (TRISS). Results: This study revealed epidemiological data of blast injury in the three tertiary military hospital. A total of 94 cases of blast injury had occurred. Various body regions were involved. The most frequently injured site was the upper extremity (52.1%). The mechanisms for the blast injuries were primary (41.5%), secondary (74.5%), tertiary (7.4%), and quaternary (29.8%). The mean injury-to-hospital arrival time was $3.2{\pm}1.7hour$. The rate of admission was 88.3%, and the rate of ICU admission was 32.5%. Thirty-six (36) cases required an emergency operation. Most were performed by an Orthopedist (55.6%), an Ophthalmologist (19.4%), or a general surgeon (13.9%). The mortality rate from blast injury was 4.3%. Conclusion: This was the first paper to present data on the type of injury, the site of injury, the cause of death, and the mortality from blast injury in South Korea. Chest injury, brain injury, tertiary injury mechanisms, $ISS{\geq_-}16$, and a Maximal Abbreviated Injury Scale Score $(ABI){\geq_-}4$ were significantly associated with death.

• Journal of Trauma and Injury
• /
• v.21 no.2
• /
• pp.85-90
• /
• 2008

Purpose: Supraventricular arrhythmia is a well-known complication of cardiothoracic surgery, and is common in patients wirth underlying cardiovascular disease. Also, it's treatment and prognosis are well known. However the incidence, the contributing factors, and the prognosis for supraventricular arrhythmias in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, the clinical presentation, the prognosis, and the factors comtributing to the prognosis for supraventricular arrhythmia in the surgical intensive care unit. Methods: We performed a retrospective study of 34 patients with newly developed or aggravated supraventricular arrhythmias in the surgical intensive care unit between March 2004 and February 2005. The incidence, the risk factors, and the prognosis of supraventricular arrhythmias were analyzed. Results: During a 12month period, the incidence of supraventricular arrhythmia was 1.79% (34/1896). Most patients had pre-existing cardiovascular disease and sepsis. The mortality rate was 29.4%, and the most common cause of death was multiple organ failure due to septic shock. The mean value of the APACHE II score was 20.9, and the surgical intensive care unit and the hospital lengths of stay were 9.9 days and 25.8 days, respectively. The APACHE II score measured when the arrhythmia developed was a significant factor in predicting mortality, Conclusion: Supraventricular arrhythmias result in increased mortality and increased length of stay in both the surgical intensive care unit and the hospital. The arrhythmia itself did not cause death, but a high APACHE II score incicated a poor prognosis. This may reflect the severity of the illness rather than an independent contributor to mortality.