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Case Reports
Massive traumatic abdominal wall hernia in pediatric multitrauma in Australia: a case report
Sarah Douglas-Seidl, Camille Wu
J Trauma Inj. 2023;36(4):447-450.   Published online November 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0023
  • 419 View
  • 10 Download
AbstractAbstract PDF
Traumatic abdominal wall hernia is a rare presentation, most commonly reported in the context of motor vehicle accidents and associated with blunt abdominal injuries and handlebar injuries in the pediatric population. A 13-year-old boy presented with multiple traumatic injuries and hemodynamic instability after a high-speed motor vehicle accident. His injuries consisted of massive traumatic abdominal wall hernia (grade 4) with bowel injury and perforation, blunt aortic injury, a Chance fracture, hemopneumothorax, and a humeral shaft fracture. Initial surgical management included partial resection of the terminal ileum, sigmoid colon, and descending colon. Laparostomy was managed with negative pressure wound therapy. The patient underwent skin-only primary closure of the abdominal wall and required multiple returns to theatre for debridement, dressing changes, and repair of other injuries. Various surgical management options for abdominal wall closure were considered. In total, he underwent 36 procedures. The multiple injuries had competing management aims, which required close collaboration between specialist clinicians to form an individualized management plan. The severity and complexity of this injury was of a scale not previously experienced by many clinicians and benefited from intrahospital and interhospital specialist collaboration. The ideal aim of primary surgical repair was not possible in this case of a giant abdominal wall defect.
Summary
Free Flap Reconstruction in Patients with Traumatic Injury of the Forefoot
Shin Hyuk Kang, Jeongseok Oh, Seok Chan Eun
J Trauma Inj. 2019;32(3):187-193.   Published online September 30, 2019
DOI: https://doi.org/10.20408/jti.2019.018
  • 5,425 View
  • 60 Download
  • 1 Citations
AbstractAbstract PDF

Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to flap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.

Summary

Citations

Citations to this article as recorded by  
  • Functional Reconstruction of Arches of the Foot With Vascularized Fibula Flap
    Fatih Zor, Yalcin Bayram, Yalcin Kulahci
    Annals of Plastic Surgery.2023; 91(5): 571.     CrossRef
Concise Bedside Surgical Management of Profound Reperfusion Injury after Vascular Reconstruction in Severe Trauma Patient: Case Report
Hoe Jeong Chung, Seong yup Kim, Chun Sung Byun, Ki Youn Kwon, Pil Young Jung
J Trauma Inj. 2016;29(4):204-208.   Published online December 31, 2016
DOI: https://doi.org/10.20408/jti.2016.29.4.204
  • 2,597 View
  • 27 Download
AbstractAbstract PDF
For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.
Summary
Original Article
Reconstruction of Soft Tissue Defect with Free Flap in Pediatric Patients
Jin Woo Song, Joon Pio Hong
J Korean Soc Traumatol. 2010;23(2):157-162.
  • 1,055 View
  • 3 Download
AbstractAbstract PDF
PURPOSE
Free flap reconstruction in the pediatric population is difficult. However, microsurgery has had remarkable success rates in children. The aim of study is to present our clinical experience using free flap for reconstruction of soft tissue defects in children and to describe long-term follow-up results.
METHODS
Between June 2002 and July 2010, 30 cases of pediatric reconstruction were performed with free flap. The authors analyzed several items, such as the kind of flap, associated complications, and growth problems.
RESULTS
Among the 30 cases, 21 cases were due to traffic accidents, 5 to cancer, and 4 to falls and other soft tissue defects. The lower leg and foot were the most common sites of the lesion. In the free flap operations we have done, 20 cases involved an anterolateral thigh perforator free flap, 6 a superficial circumflex iliac perforator free flap, and 4 an upper medial thigh perforator free flap. In early postoperative complications, partial necrosis was seen in 2 cases, infection in 1 case, and the hematoma in 1 case. A satisfactory success rate and functional results were achieved.
CONCLUSION
Free flap reconstruction in children allows satisfactory function with no significant effect on growth. Free flaps are regarded as the primary choice for selective pediatric reconstructive cases.
Summary

J Trauma Inj : Journal of Trauma and Injury