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7 "Thoracotomy"
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Case Reports
Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report
Zryan Salar Majeed, Yad N. Othman, Razhan K. Ali
J Trauma Inj. 2023;36(3):253-257.   Published online April 19, 2023
DOI: https://doi.org/10.20408/jti.2022.0073
  • 1,059 View
  • 35 Download
AbstractAbstract PDF
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.
Summary
Chest Wall Reconstruction for the Treatment of Lung Herniation and Respiratory Failure 1 Month after Emergency Thoracotomy in a Patient with Traumatic Flail Chest
Junepill Seok, Il Jae Wang
J Trauma Inj. 2021;34(4):284-287.   Published online August 31, 2021
DOI: https://doi.org/10.20408/jti.2020.0059
  • 8,045 View
  • 89 Download
AbstractAbstract PDF

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-year-old female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and “on the way out” SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

Summary
Special Article
Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology
Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(3):195-203.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0050
  • 10,258 View
  • 184 Download
AbstractAbstract PDF

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

Summary
Case Reports
Chronic Traumatic Glass Foreign Body Removal from the Lung through a Direct Parenchymal Incision
Su Young Yoon, Si Wook Kim, Jin Suk Lee, Jin Young Lee, Jin Bong Ye, Se Heon Kim, Young Hoon Sul
J Trauma Inj. 2019;32(4):248-251.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.031
  • 3,819 View
  • 56 Download
  • 1 Citations
AbstractAbstract PDF

Traumatic intrapulmonary glass foreign bodies that are missed on an initial examination can migrate and lead to severe complications. Here, we present a rare case of a traumatic intrapulmonary glass foreign body surgically removed by a direct pulmonary incision, which preserved the pulmonary parenchyma and avoided severe complications caused by migration.

Summary

Citations

Citations to this article as recorded by  
  • Thoracoscopic retrieval of an intrapulmonary sewing needle: A case report
    Houssem Messaoudi, Imen Ben Ismail, Wafa Ragmoun, Hatem Lahdhili, Saber Hachicha, Slim Chenik
    Clinical Case Reports.2020; 8(12): 2494.     CrossRef
Emergency Repair Using Cervico-median Sternotomy for Cervicothoracic Penetrating Injury
Hyun Joo Lee, Hyun Koo Kim, Young Ho Choi
J Korean Soc Traumatol. 2008;21(2):136-139.
  • 1,315 View
  • 1 Download
AbstractAbstract PDF
A great variety of penetrating injuries is happening due to the increasing population and violence today. An optimal surgical approach is the key factor for successful repair of a complicated penetrating injury. A 23-yearold woman fell down the stairs from the second floor and received cervico-thoracic penetration injury due to a metalic bar. The metalic bar ruptured the right jugular vein and penetrated the left upper and lower lung. Under cervico-median sternotomy, neck vessels were repaired and the left thorax was successfully entered to repair the damaged lung through the mediastinal pleura. With this approach, the patient's position did not need to be changed during operation, while reduced the operation time compared to the conventional approach (cervical incision and standard thoracotomy).
Summary
Original Article
Management of Traumatic Diaphragmatic Rupture
Seon Hee Kim, Jeong Su Cho, Yeong Dae Kim, Ho Seok I, Seunghwan Song, Up Huh, Jae Hun Kim, Sung Jin Park
J Trauma Inj. 2012;25(4):217-222.
  • 1,477 View
  • 12 Download
AbstractAbstract PDF
PURPOSE
Diaphragmatic rupture following trauma is often an associated and missed injury. This report is about our experience with treating traumatic diaphragmatic rupture (TDR).
METHODS
From January 2007 to September 2012, 18 patients who had a diaphragmatic rupture due to blunt trauma or penetrating injury underwent an operation for diaphragmatic rupture at our hospital. We retrospectively reviewed their medical records, including demographic factors, initial vital signs, associated injuries, interval between trauma and diagnosis, injured side of the diaphragm, diagnostic tools, surgical method or approaches, operative time, herniated organs, complications, and mortality.
RESULTS
The average age of the patients was 43 years, and 16 patients were male. Causes of trauma included motor vehicle crashes (n=7), falls (n=7), and stab wounds (n=5). The TDR was right-sided in 6 patients and left-sided in 12. The diagnosis was made by using a chest X-ray (n=3), and thorax or upper abdominal computed tomography (n=15). Ten(10) patients were diagnosed within 12 hours. A thoracotomy was performed in 8 patients, a video-assisted thoracoscopic surgery in 4 patients, a laparotomy in 3 patients, and a sternotomy in one patient. Herniated organs were the omentum (n=11), stomach (n=8), spleen and colon (n=6), and liver (n=6). Eighteen diaphragmatic injuries were repaired primarily. Seven patients underwent ventilator care, and two of them had pneumonia and acute respiratory distress syndrome. There were no operative mortalities.
CONCLUSION
Early diagnosis and surgical treatment determine the successful management of TDR with or without the herniation of abdominal organs. The surgical approach to TDR is chosen based on accompanying organ injuries and the injured side.
Summary
Case Report
A Case of Cardiac Laceration due to Anterior Thoracic Stab Injury
Won Gi Woo, Ji Young Jang, Seung Hwan Lee, Chang Young Lee, Jae Gil Lee
J Trauma Inj. 2014;27(3):71-74.
  • 1,443 View
  • 5 Download
AbstractAbstract PDF
Among chest trauma patients, cardiac laceration is a rare, but severe, condition requiring prompt management. Depending on the patient's hemodynamic status, early detection rate of a cardiac laceration may or may not be occur. If a possibility of cardiac laceration exists, an emergent thoracotomy should be performed. Furthermore, patients who experience a cardiac laceration also experience different kinds of complications. Therefore, close follow-up and monitoring are required. Herein, we report a 41-year-old man with a left atrium and a left ventricle laceration caused by a thoracic stab injury.
Summary

J Trauma Inj : Journal of Trauma and Injury