ABSTRACT
PURPOSE: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. METHODS: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. RESULTS: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. CONCLUSION: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient's status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality.
Subject(s)
Humans , Accidents, Traffic , Blood Pressure , Coma , Creatinine , Emergency Service, Hospital , Equidae , Incidence , Intestine, Small , Intestines , Liver , Mesentery , Mortality , Multivariate Analysis , Pancreas , Platelet Count , Postoperative Complications , Resuscitation , Risk Factors , Shock , Spleen , Thoracic Injuries , Violence , Wound InfectionABSTRACT
This paper represents the versatility of buccinator myomucosal flap for intraoral and orbital reconstruction of mild to moderate defect and we introduce recontructive methods are introduced along with our clinical experience. Buccal artery from internal maxillary artery is the main arterial pedicle, and buccal branch from facial artery also can supply blood for the buccinator muscle. The abundant blood flow from interconnected pedicles supports the reliable circulation of the buccal mucosa. So we could reconstruct the eye socket using reversed island buccinator myomucosal flap based on the angular vessel. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator muscle is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication and voiding the buccal cavity. From 1990 to 1999, the flap was utilized in 8 patients to reconstruct the small to moderate intraoral defect and 1 patient for orbital mucosal defect. All flaps survived completely. There has been no flap necrosis and fistula. The results have been functionally and esthetically satisfactory. It is very reliable and safe flap with a minimal morbidity of donor site. It doesn't require microsurgical technique. Rapid healing may be achieved with its mucosal nature. We conclude that buccinator myomucosal flap can be widely used with a lot of advantages for intraoral and orbital defect because of its many advantages.
Subject(s)
Humans , Arteries , Facial Nerve , Fistula , Mastication , Maxillary Artery , Mouth Mucosa , Mouth , Necrosis , Orbit , Singing , Tissue DonorsABSTRACT
Spontaneous esophageal perforation(Boerhaave's syndrome) is rare but associated mortality and morbidity are high and causes death in the absence of therapy. The diagnosis of Boerhaave's syndrome is very difficult, as a result, the delay significantly increases the complication rates. We experienced that a 54 year old man was treated by using successfully the flexible covered esophageal stent because of a very long delay diagnosis of esophageal perforation. He was discharged 3 days after the esophageal stent insertion. The post-stent insertion was an uncomplicated course and remained well on opd follow up.
Subject(s)
Humans , Middle Aged , Diagnosis , Esophageal Perforation , Follow-Up Studies , Mortality , StentsABSTRACT
Breast cancer is the second leading cause of cancer death in women. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. The purpose of the study is to analyze the results of breast reconstruction using free transverse rectus abdominis myocutaneous(TRAM) flap and to suggest the operative technique for more satisfactory results. 19 patients underwent immediate breast reconstruction from 1990 to 1998, and we experienced 2 cases of bilateral immediate reconstruction of breasts following mastectomy. We have performed the free TRAM flaps based on the deep inferior epigastric vessels using microvascular technique. TRAM flap included very small portion of rectus sheath and muscle-so called muscle sparing technique. So it reduced markedly donor site morbidity. The postoperative course of these cases was uneventful with minor complication. The free TRAM flap was an excellent method of immediate breast reconstruction using autogenous tissue and provided satisfactory outcome. The goals of the immediate breast reconstruction after mastectomy are to restore body image, to achieve near normal shape of breast, and to reduce the complications. This paper represents our experience of immediate breast reconstruction using free TRAM flap, and technical options to get more satisfactory result and reduce the complications. We think this method could be regarded as the first choice for immediate breast reconstruction.
Subject(s)
Female , Humans , Body Image , Breast Neoplasms , Breast , Korea , Mammaplasty , Mastectomy , Rectus Abdominis , Tissue DonorsABSTRACT
Microsurgical reconstruction is necessary for children to correct severe trauma and congenital or acuqired deformity. The aim of this study was to evaluate whether or not microsurgical reconstruction is a safe and reliable operation in children and to analyze the differences of microsurgical reconstruction in children compared to adults. The study included 12 children who underwent 13 microsurgical reconstructions among a total of 251 cases of microsurgical reconstruction from May, 1986 to August, 1998. Their ages ranged from 24 months to 14 years and 8 months. There were 7 males and 6 females. The involved sites were 9 legs, 3 hands and 1 face. The causes of microsurgical reconstruction were 9 traumas, 2 congenital anomalies, 1 acquired deformity and 1 cancer. The applied flaps were 4 scapular flaps, 2 rectus abdominis muscle flaps, 1 de-epithelized groin flap, 1 lateral arm flap, 1 forearm tendocutaneous flap, 1 forearm tendocutaneous flap, 1 latissimus dorsi muscle flap, 1 fibula flap, 1 second toe transfer, and 1 wrap-around flap. All patients have had normal growth of the donor and recipient sites without specific complications during an average 2 years follow-up. We concluded that microvascular reconstruction is a very useful and reliable procedure in children if it is performed in consideration of each child's specific characteristics and conditions.
Subject(s)
Adult , Child , Female , Humans , Male , Arm , Congenital Abnormalities , Fibula , Follow-Up Studies , Forearm , Groin , Hand , Leg , Rectus Abdominis , Superficial Back Muscles , Tissue Donors , ToesABSTRACT
There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Subject(s)
Child , Female , Humans , Male , Dentition , Diagnosis , Facial Bones , Follow-Up Studies , Incidence , Mandible , Nasal Bone , Orbital Fractures , Physical Examination , Postoperative Care , Tomography, X-Ray Computed , Transplants , Ultrasonography , ZygomaABSTRACT
Primary treatment of cleft palate should result in an intact palate with separation of the oral and nasal cavities. However, the published reports of large series indicate that palatal fistula present in operated cleft palate of a small but significant groups of patients. Even in the best hands, a palatal fistula of the operated cleft palate may reoccur postoperatively. Various methods of repair including local mucosal flaps have been employed to date, but fistula repair is extremely difficult because the operative field is limited by scar formation around the palatal fistula, making wound healing unsatisfactory. In such cases, a tongue flap is commonly indicated. From May of 1991 to May of 1996, among 19 patients with palatal fistula in operated cleft palate, 11 patients were operated by anteriorly-based tongue flap. All patients were followed up for at least 6 months, with mean follow up of 18 months. Among 12 cases of 11 patients included in this study, 11 flaps survived and did not recur during follow up periods. One complication was seen in the first case. In this case, there was a flap detachment from the recipient site on the 3rd postoperative day, but he was treated successfully at a subsequent operation. There have been no problems with feeding and communication until the pedicle is cut, and no patient experienced problems either with alteration in speech or with disturbance of taste sensation following surgery. In conclusion, this study shows that the anteriorly-based tongue flap is a safe and reliable technique for closure of large palatal fistula.
Subject(s)
Humans , Cicatrix , Cleft Palate , Fistula , Follow-Up Studies , Hand , Nasal Cavity , Palate , Sensation , Tongue , Wound HealingABSTRACT
A very rare case of mycotic aneurysm in the descending thoracic aorta due to salmonellosis was treated in our hospital. The patient was a 62 year-old male who 48 days before the operation was admitted to the department of internal medicine complaining of fever, nausia, vomiting, and loose stool. He was treated for 35 days and discharged. Three days after discharge, however, the patient was readmitted to the hospital complaining of right upper quadrant abdominal pain. Fever developed on the third hospital day, and on the eighth hospital day, the patient complained of back pain and epigastric pain. A simple chest x-ray showed evidence of hemothorax in the left plueral space, and therefore, computed tomography of the chest was done. The patient was diagnosed as a ruptured mycotic aneurysm of the descending thoracic aorta, and was transferred to our Department of Thoracic and Cardiovascular Surgery. The aneurysm and infected tissues was widely debrided, and the site was then patched with a Dacron graft. Salmonella choleraesuis was identified in the blood and aneurysm cultures, and antibiotics were administered for 6 weeks according to the sensitivity of the organism. The patient experienced no complication thereafter and for the last three months since the operation, he has been leading a healthy and normal social life.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Aneurysm , Aneurysm, Infected , Aneurysm, Ruptured , Anti-Bacterial Agents , Aorta, Thoracic , Arteritis , Back Pain , Fever , Hemothorax , Internal Medicine , Polyethylene Terephthalates , Salmonella Infections , Salmonella , Thorax , Transplants , VomitingABSTRACT
Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistula formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelialized (5 mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejuna transfer.
Subject(s)
Humans , Constriction, Pathologic , Fistula , Forearm , Free Tissue Flaps , Head , NeckABSTRACT
No abstract available.
ABSTRACT
Hand injury in children was increased due to multiple environmental risks and failed attention of parents to children in rapidly developing society. By the results of this evaluation in 37 cases, it was summarized as follows. First, hand injuries in children most commonly occurs in spring, and occurs more commonly in the children at the age of high activity. The most common level of injury is zone I by microreplantation zone, and zone II by tendon injury zone. The more desirable results were obtained by full thickness skin graft and composite graft if it were possible. For the better functional results compare to adults, the methods and procedures must be constructed after more evaluation with more clinical cases. In the cases of pediatric hand injury, the most important fact is prevention of injury, with the close attention by parents, and the second is appropriate diagnosis and treatment for more functional results.
Subject(s)
Adult , Child , Humans , Diagnosis , Hand Injuries , Hand , Parents , Skin , Tendon Injuries , TransplantsABSTRACT
We report 2 cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap. In these cases, the main points to cover the defects were as follows: 1. For the contour of zygoma and maxilla, it was well preserved without bone graft which was not used for second stage reconstruction. In first case, for application of artificial eyes and in second case, for operation after full development. 2. For the drainage of paranasal sinuses, we made the nostril with skin graft, and it was well preserved without any complications during follow up. 3. It was sufficient to cover the defect with latissimus dorsi muscle well designed before surgery and thick enough to fill the defect. 4. In second case, the remained defect of palate and maxilla was not covered for the appropriate reconstructions after full development. In conclusions, we experienced two cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap without any complication and with good results.
Subject(s)
Drainage , Eye, Artificial , Follow-Up Studies , Free Tissue Flaps , Maxilla , Palate , Paranasal Sinuses , Skin , Superficial Back Muscles , Transplants , ZygomaABSTRACT
Horizontal Mattress Suture Technique on Microvascular Anastomosis of rat (body weight: 200-250 gm) femoral artery was evaluated. The present study was conducted to compare the horizontal mattress suture with simple interrupted suture on the suture time, patency rate of the sutured vessels, and the histological changes of surgical site of the vessel wall during wound healing period. The mean suture time of the vessel wall with horizontal mattress suture technique was 15 min 49 sec ± 2.14, which is significantly shorter than that of simple interrupted suture technique. The patency rate of the sutured vessel in both groups was statistically not different each other till post-operative 3rd day but patency rate of horizontal mattress suture was higher than that of simple interrupted suture at post-operative 3rd week. The histological findings such as intimal noss, medial degeneration and intimal regeneration were similar in both groups.
Subject(s)
Animals , Rats , Femoral Artery , Regeneration , Suture Techniques , Sutures , Wound HealingABSTRACT
Augumentation rhinoplasty using autogenous cranial bone graft (outer table) can be used more successfully than other methods. In patients with congenital or posttraumatic severe saddle nose deformity and lateral deviation, cranial bone graft is an excellent method of augumentation. The advantages of cranial bone graft compared with traditional method of bone graft are summarized as follows; 1. Easy to reach donor site 2. Abundance of material 3. Little pain and functional disability 4. Shorter hospitalization period 5. Inconspicuous donor scar 6. No secondary deformity of donor site 7.Appropriate curvature can be obtained by proper selection of donor site. With the above advantages, we conclude that augumentation rhinoplasty using split cranial bone graft is a good method in correction of congenital or posttraumatic deformity of nose.