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Volume 3(1); June 1990
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외상센타 설립의 필요성
J Korean Soc Traumatol. 1990;3(1):1-3.
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Summary
The Patient Outcome According to Transportation Time and Type in Multiple Trauma Patients
Kyoung Soo Lim
J Korean Soc Traumatol. 1990;3(1):4-15.
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First aids on scene and field triage are required to multiple injured patients. So well tra-ined EMT(Emergency Medical Technician) and Emergency car equipped with emergent medical equipments are need for pre? hospital stabilization of patients. Especially in Kan-won-Do, there has been high incidence of traffic accident and relatively higher mortality in comparison to injury severity because of geographic characteristics. Over a 4-month period 1.083 multiple trauma patients admitted to the Wonju Christian HospitaJ were studied pro-spectively. The patients transported by car without emergency treatment were likely to show higher mortality (18/264) than those transported by ambulance after emergency treatment at regional hospital (36/819). And patients transported within 1 hour were lik-ely to show good result than those transported above 1 hour. Althogh the causes of death in severe injured patients (lSS≥16) are head injury, hemorrhage and chest injury, thoses in mild injured patients (ISS<16) are airway probl ms that were prevental death by rapid airway control on scene. I conclude that trauma triage system or EMS (Emergency Medical Serivces) systems would be oranized in recent time and trauma center with trauma team is need for multiple trauna patients.
Summary
The Value of Abdominal Trauma Index in Abdominal Trauma
Youngmin Suh, Hoon Sang Chi, Byung Ro Kim
J Korean Soc Traumatol. 1990;3(1):13-31.
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The abdominal trauma index(ATI) is a method of quantifying the risk following abdominal trauma. The index is calculated by the sum of the individual organ scores which are calculated by assigning a risk factor to each organ injured and then multiplying this by a severity of injury estimate. We reviewed 103 patients undergoing laparotomy for abdominal trauma at the Yong Dong Severance Hospital from 1983 to 1988. This series were analyzed by scoring of ATI. The result of our study showed that, when the ATI was 25 or less the morbidity rate following abdominal trauma was 18%, whereas 50% of morbidity rate when the ATI exceded 25, and the mortality rates of each group were 3% and 20%, respectively. Thlis objective assessment of the risk of complication following abdominal trauma would assist the identification of high risk patient and appropriate allocation of operative and postoperative care. Moreover, as a field triage, ATI may assist in decision of transfer of patients to various medical care units. Using the ATl, comparison of the qualities of emergency systems would be justificably analyzed by the objective scoring system.
Summary
Abdominal trauma in children
Suk Koo Lee, Seung Rak Lee, Soo Tong Pai
J Korean Soc Traumatol. 1990;3(1):20-46.
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Trauma is the leading cause of death in children. Thirty-three children were treated for abdominal trauma from αtober 1986 to September 1990 in Kangdong Sacred Heart Hospital. The majority of patients (75.8%) was between four and nine years old. There were 25 males and eight females. The most common causes of injury were pedestrian traffic accidents(57.6%) foil wed by falls(24.2%). Seventeen of 22 children, transfered directly from injured site were evaluated at our emergency room within 1 hour of their injuries. If a pat ient was hemodynamically stable after initial resuscitation, ultrasonography and computed tomography were effective tools in the diagnosis and evaluation of the abdominal trauma in children. Serum transaminases were reliable valu~s for liver injuries. The most frequently injured abdominal organ was a liver followed by a spleen. Thirteen(39.4%) were treated nono야ratively without complications. Nineteen childre (57.6%) were transfused during initi허 resuscitation or after resuscitation because of decreasing blood counts. Overall mortality was 12.1%. The causes of death were lethal head injuries in three cases and severe hepatic vein and Ive injury in one case. Mortality was related to the number of organ systerns injured, presence of head injury and injury severity score (ISS) more than 30. We consider that nonoperative treatment appears to be a safe and satisfactory approach to the carefully selected pediatric patients with abdominal trauma, who are hemodynamically stable. I t is our opinion that there preferably should be a standard procedure in dealing with injured patients in order to avoid confusion in the evaluation and treatment of the patient with severe trauma in children
Summary
The Reconstrution of The Frontal Depressions Using Various Methods
Jeong Tae Kim, Hee Youn Choi
J Korean Soc Traumatol. 1990;3(1):28-62.
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Since the frontal area is the most cosmetically obvious, a slight distortion of symmetry or deperssion renders gross changes in appearance and is a significant handicap for the pat-ients. Frontal depressions or bons defects afther trauma or operation are not only a cos-metically significance, but also aprotective role for brain. We have experienced 5cases of the reconstructions for frontal depressions with the ope-rations using autogenous bone grafts, dermofat grafts, methyl methacryate contouring or parascapular free flap.The results were satisfactory escept one, absorption of grafted bon-e. We also preferrde methyl methacrylate in the cases of no cranial bone defect or large cranial bone defect and autogenous bone grafts in small cranial bone defects.
Summary
Reconstruction of Blowout Fracture of Orbital Floor Using Outer-table Calvarial Bone Graft
Jin Kim, Hee Youn Choi
J Korean Soc Traumatol. 1990;3(1):36-78.
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Orbital implants used in repairing the blowout fracture must have some physical properties to restore the contour and dimensions of the orbit, and to provide some indirect support for the glove. Also, they should provide a physiologically accepttable and physically inert smooth surface which will not form adhesions. Oculoplastic surgerns have been used many materials for the reconstruction of the orbital floor including alloplastic implants, autogenous bone and autogenous cartilage, but any of them was not choosen as the most proper implant in repairing the blowout frature owing to various disadvantages. Authors have used outer-table calvarial bone segments preserving the periosteum in the reconstruction of blowout fracture. We have implanted this material in 13 patients for last 2 years. Satisfactory functional and cosmetic results were achieved in 12 patients without noticeable complications. One patient showed slight undercorrection of the preoperative enopthalmos, but the patient satisfied after second operation for the reimplantion of another outer-table calvarial bone segment. No patient complained remnant diplopia or other major complications including infection and displacement of implant. Authors believe that the outer-tabe calvarial bone segment is the ideal implant for use in repairing the blowout fracture. In this paper we would like to present the operative technique, the advantages of the implant and related bibliographical review .
Summary
New island flap techniques in fingertip injury reconstruction
Myong Chul Park, Jin Han Cha
J Korean Soc Traumatol. 1990;3(1):44-94.
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Department of Plastic and Reconstructive Surgery, College of Medicine, Konkuk University, Seoul, Korea Fingertip is the part of the hand most frequently injured. Nail bed and fingertip injuries often result in time lost from work and even can be permanently disabling if imporperly repaired. The ideal fingertip reconstruction should attempt to maintain length, preserve nail functon, and provide sensate soft tissue covering without pain during use. Two kinds of island flaps based on single neurovascular bundle were used for fingertip reconstruction. The step-advancement island flap incorperated the step ladder principle with full tactile sensibility in the required position with the good soft tissue support. Innervated reverse vascular pedicle digital island flap is based on the digital palmar arch which is the anastomosis between the radial and ulanr sides of the finger at the level of 1/2 of middle finger.Sensation could be provided by the anastomosis between divided digital nerve and dissected digital nerve branch of the island flap. We report 25 cases of fingertip inj ury repaired with two kinds of new island flap techniques.
Summary
Delayed Traumatic Intracerebral Hematoma -Report of 3 Cases-
Dong Ho Kim, Mou Seop Lee
J Korean Soc Traumatol. 1990;3(1):52-108.
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Three patients are reported who developed delayed intracerebral hematomas following head injuries. One patient showed hematoma within 3 days after a normal computerized tomogram. The other patient developed multiple intracerebral hematomas within 28 hours after falling down from stairs, whose initial computerized tomogram exhibited only mild brain swelling. He had emergency craniotomy for frontal lobectomy but died on postoperative 6th day. Another patient developed hematoma within 7 days following head trauma, wo had good result with conservative treatment. Hematomas occured in contre coup injuries in all three cases.
Summary
Delayed Diagnosed Diaphragmatic Rupture -2 cases report-
Doo Yun Lee, Jung Hyun Bang, Ho Kyung Kim, Sang Jin Kim
J Korean Soc Traumatol. 1990;3(1):58-121.
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The diaphragmatic rupture is very rare disease which have to be repaired with emergency operative procedures. But this diaphragmatic rupture could not be detected in early period because of emergency care of other critical combined injuries in some cases. We had experienced 2 cases who had the delayed repair of diaphragm, 9 months, and 10 years after primary treatment of major lesions due to car accident in the Department of Thoracic and Cardiovascular surgery Yonsei University Collge of medicine recently. The two cases are uneventful in postoperative courses 4 months and 1 years after the repair of ruptured diaphragm.
Summary
A Case of Traumatic Duodenal Hematoma: An observation of Natural Course of Severe Duodenal Hematoma
Seong Cheol Lee, Ho Suk Lee, Sung Eun Jung
J Korean Soc Traumatol. 1990;3(1):65-132.
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Intramural duodenal hematoma secondary to blunt abdomial trauma is a rare abdominal injury. Until early 1970s operation was preferred management. But after successful non-operative management of duodenal hematoma in 8 out of 9 children by Holgerson and Bis-hop in 1977 it is generally managed nonoperatively in children. But in 1988 Thoms and Ric-ketts reported 3 consecutive cases which they failed to manage nonoperatively and rec-ommeded surgical intervention when 10 days of medical management fails to achieve complete resolution. We experienced a natural course of duodenal obstruction by intramural hematoma and subsequent fibrosis which necessiated duodenojejunostomy 166 days after abdominal trauma in 7 year-old boy. We reviewed our case and agree with Thoms and Ricketts recommendation.
Summary

J Trauma Inj : Journal of Trauma and Injury