Objectives : To examine the clinical and preoperative evaluation results of treating Gustilo type III B open fractures of the tibia with soft tissue defects by the pedicle flap transfer method. Materials and Methods : Between 2011 and 2015, 8 cases of tibia fracture with soft tissue defects in 7 males and 1 female aged 20-72 years were treated at our institution. We evaluated each case using the AO soft-tissue grading system and Ganga Hospital Scoring System (GHS), which are specifically designed to evaluate III B injuries. Results : According to the AO soft-tissue grading system, 1 case was MT1, 5 cases were MT2, and 2 cases were MT3. On the scoring of functional tissues by musculotendinous (MT) and nerve units based on the GHS, 1 case had a score of 1, 5 cases had a score of 2, and 2 cases had a score of 3. Two flaps that were MT3 with a score of 3 were lost to necrosis. Conclusion : Pedicle flap transfers can be performed for Gustilo type III B tibia fractures that have an AO soft-tissue grading system score up to MT2 and GHS musculotendinous functional tissues score up to 2.
Background : The diagnostic rate of blunt diaphragmatic injuries (BDIs) has improved with the use of multi-detector computed tomography (MDCT). However, we believe that cases for which a diagnosis is difficult still exist. We evaluated the limitations in diagnosing BDIs using MDCT based on diaphragmatic injury (DI) size. Methods : We retrospectively examined 15 patients with BDIs who underwent preoperative MDCT before operative treatment between January 2006 and December 2015. Clinical features, preoperative diagnostic rate, and diaphragmatic injury findings were evaluated. Results : Study subjects comprised ten men and five women (mean age, 48 years). Road traffic accidents were the main cause of injury. The average DI size was 13.1 ± 9.1 (range 1-33) cm. A diagnosis of BDI was missed in two patients with very small DIs without hernia (preoperative diagnostic rate, 86.7%). Conclusions : Diagnosing MDCT is still challenging for patients with small sized DI without hernia.
We reported two patients who underwent emergency laparotomy and thoracic endovascular aortic repair (TEVAR) for traumatic abdominal and thoracic aortic injuries. Case 1 : Emergency laparotomy was performed for intra-abdominal hemorrhage following an accidental fall. Postoperative computed tomography (CT) revealed thoracic aortic injury and extravasation from the left renal artery. We performed transcatheter arterial embolization for the left renal artery bleeding and TEVAR for thoracic aortic injury. Case 2 : A patient injured in a traffic accident was transferred to our department. Trauma pan-scan demonstrated thoracic aortic injury, free air and extravasation in the abdomen, and unconfirmed contrast in the left femoral artery. We performed femorofemoral bypass for left lower limb ischemia, emergency laparotomy for gastrointestinal perforation with intra-abdominal hemorrhage, and TEVAR for thoracic arterial injury. Currently, endovascular aortic repair is widely performed for traumatic aortic injuries. This procedure has good efficacy in cases with multiple injuries.
In recent years, chest wall fixation has been reported to be useful for reducing the duration of both mechanical ventilation and intensive care unit stays for patients with flail chest. At our hospital, we perform chest wall fixation in a positive manner with a titanium mandible locking plate (Matrix MANDIBLE® DePuy Synthes). Herein, we present clinical evaluations of four patients with flail chest (multiple rib fractures in three and sternal fracture in one) who underwent chest wall fixation at our hospital over the past two years. We consider this approach to be useful for flail chest because of quick weaning from mechanical ventilation after surgery, and its fixation strength and firm reconstruction of the chest wall.