Journal of Trauma and Injury最新文献

Purpose: The acute care surgery (ACS) model establishes the capacity to immediately accommodate nontraumatic emergency surgery requiring urgent treatment while simultaneously elevating the existing trauma care system to the highest level. This study aims to evaluate the 4-year experience of operating after expanding the trauma surgery domain to ACS at this institution, which was designated as a lower-level trauma center by the local government in 2020.

Methods: A retrospective study was conducted using clinical records for patients who underwent surgery in the Division of Trauma and Acute Care Surgery over a 54-month period, from March 2021 to August 2025.

Results: Trauma volumes remained stable (10-20 cases semiannually) after ACS implementation, with surgical case numbers similar to those recorded before its introduction. Nontrauma volumes increased from 3 cases in March-August 2023 to 163 in March-August 2025.

Conclusions: The transition from the trauma surgery model to the ACS model successfully increased the efficiency of trauma and emergency general surgery within the level II low-volume environment, accomplishing without reducing the existing trauma caseload. These findings support the adoption of ACS in similar emergency medical institutions and offer insights relevant for national policy development concerning emergency general surgery in Korea.

Subclavian vessel injury concomitant with a closed clavicle fracture is rare, and challenges associated with exposure often make proximal control difficult. This paper presents the case of a 26-year-old man who presented to the emergency department after a fall from the sixth floor with multiple injuries, including closed clavicle fractures and a subclavian artery pseudoaneurysm. Proximal control was achieved with endovascular balloon occlusion rather than by performing cervical extension of median sternotomy. Subsequently, exposure was obtained through a subclavian incision, and the injury was treated with a bypass graft.

We report a case of iatrogenic injury to the lateral circumflex femoral artery following distal femoral nailing in a 72-year-old patient. Postoperatively, progressive thigh swelling developed, but initial contrast-enhanced computed tomography (CT) showed no evidence of vascular injury. The arterial injury was subsequently identified on a follow-up contrast-enhanced CT scan and was successfully treated with angiographic microcoil embolization. This case underscores the critical importance of meticulous awareness of the trajectories of the lateral circumflex and deep femoral arteries during proximal interlocking screw insertion. It also highlights that early postoperative imaging can fail to detect such vascular complications. Therefore, a high index of clinical suspicion is paramount, and repeated imaging should be strongly considered if clinical signs, such as progressive swelling, persist despite initial negative findings.

Subclavian artery injury is a rare complication of clavicular fracture. This condition most often results from penetrating trauma but may also occur after blunt injury, when bone fragments cause rupture, pseudoaneurysm, dissection, or arterial thrombosis. Subclavian artery injury associated with clavicular fracture occurs in less than 1% of cases and may lead to life-threatening hemorrhage or limb ischemia. We report a case of subclavian artery injury secondary to a clavicular fracture that was successfully managed with endovascular intervention. A 48-year-old man presented to the emergency department after a downhill bicycle crash with a right midshaft clavicle fracture and was scheduled for open reduction and internal fixation (ORIF) 11 days later. Intraoperatively, rupture of a subclavian artery pseudoaneurysm caused massive hemorrhage. Surgical dissection was complicated by severe perivascular inflammation and a high risk of iatrogenic subclavian vein injury. Immediate conversion to an endovascular approach allowed successful hemostasis through femoral artery access and covered stent deployment, after which ORIF was completed. The patient recovered without neurovascular complications and was discharged on postoperative day 5. At 12 weeks, he achieved full shoulder range of motion, and 2-year follow-up angiography showed no stent-related complications. This case underscores the effectiveness of emergent endovascular intervention for ruptured traumatic subclavian pseudoaneurysm when inflammation and risk of iatrogenic injury preclude safe open dissection. A hybrid or rescue endovascular strategy should be considered for similar complex trauma cases.

Restoring large bowel continuity after extensive resection due to abdominopelvic trauma may be challenging because of the limited length of the remaining bowel. Achieving a tension-free anastomosis can be particularly difficult when attempting this within the pelvis due to a short rectal stump. Two maneuvers that can aid in these situations are the retroileal pull-through approach and the Deloyers procedure. We describe two cases in which each maneuver was utilized to facilitate colostomy closure following extensive large bowel resection resulting from abdominopelvic trauma. Both maneuvers proved feasible, successfully allowing bowel continuity to be restored with tension-free anastomoses. Protective loop ileostomies were performed in both cases. Postoperative contrast enema studies did not show evidence of anastomotic leaks. After ileostomy closure, both patients regained bowel function with good bowel control. Bowel manipulation maneuvers following abdominal trauma are therefore feasible and facilitate tension-free anastomosis after extensive colonic and rectal resections. Trauma and colorectal surgeons managing abdominal trauma patients requiring ostomy closure should become familiar with these techniques.

Severe traumatic injuries, particularly unstable pelvic fractures, frequently result in life-threatening hemorrhagic shock, necessitating urgent transfer to specialized trauma centers. However, interhospital transport of hemodynamically unstable patients poses a significant risk of clinical deterioration. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers effective temporary hemodynamic stabilization before definitive care. Here, we describe the successful use of zone III REBOA by a surgeon-staffed emergency medical service ("doctor car") to rapidly stabilize and safely transfer a 62-year-old man with a severe bleeding pelvic fracture. Upon arrival at the trauma center, the patient underwent immediate definitive treatments, including preperitoneal pelvic packing and transarterial embolization. This case highlights the potential for integrating REBOA with physician-staffed emergency transport systems as a strategy to bridge critical gaps in regional trauma care networks and improve patient outcomes.

A 47-year-old male patient who had self-inserted a rectal foreign body for anal autoerotic purposes was admitted to the emergency department. Thirty minutes after admission, he developed chest pain and profuse sweating. Electrocardiography revealed an acute inferior myocardial infarction. Initially, the patient underwent coronary angiography, and percutaneous transluminal angioplasty was performed for a 100% occlusion of the right coronary artery. Subsequently, under general anesthesia, the foreign body was removed via rectal examination in the lithotomy position. This rare clinical scenario, which has not been previously reported in the literature, highlights the potential for psychological trauma and local rectal injury to act as triggers for myocardial infarction. Respecting patient confidentiality, maintaining a nonjudgmental approach, and implementing a multidisciplinary strategy are critically important for the effective management of such uncommon cases.

Arterial-vesical injuries are rare entities, often presenting with bladder distension, bright red hematuria, and clot retention. The few cases reported in the literature typically occur following traumatic injuries to the groin or pelvis. We present a case of an arterial and vesical injury with decompression through the bladder. Our patient was a 21-year-old man who presented to a level I trauma center as a high-level activation trauma case following a single gunshot wound to the left lateral thigh. Upon arrival, the patient's systolic blood pressure was 80/50 mmHg. A pelvic x-ray revealed ballistic fragments in the pelvis. Physical examination showed a 1+ palpable left dorsalis pedis pulse. He underwent a formal trauma laparotomy, which did not identify any acute injuries. Concurrently, his Foley catheter exhibited bloody output with bladder distension. Following continuous bladder irrigation, he had profuse sanguineous output. Angiography revealed a complete disruption of the profunda femoris artery. An open exploration of the femoral canal was performed to achieve proximal control of the common femoral artery. We identified a 3-cm longitudinal injury to the profunda femoris artery and an obliterated femoral vein, both of which were ligated, resulting in decreased bladder exsanguination and hemodynamic stabilization. Consistent with the limited published cases of arterial-vesical fistula, our patient presented after a traumatic groin injury. Maintaining a high index of suspicion for communication between the thigh and extraperitoneal space due to projectile trajectory remains crucial to successfully managing these challenging injuries.

Severe hemorrhagic shock is a leading cause of death among potentially salvageable casualties. We report the case of a 24-year-old man who sustained a gunshot wound to the right hemithorax and presented with class IV hemorrhagic shock. He underwent resuscitative damage control via a right posterolateral thoracotomy. Intraoperatively, the bleeding source was identified as a lacerated posterior intercostal artery at the level of the 11th dorsal vertebra. Because access to the bleeding site remained limited even after extending the incision, right thoracic packing was performed to control the hemorrhage. On reevaluation 48 hours later, no active bleeding was observed.