In Japan, training trauma surgeons with experience in managing gunshot wounds is important ; however, acquiring such expertise domestically is challenging. The Chris Hani Baragwanath Academic Hospital in South Africa handles a high volume of trauma cases including gunshot wounds and stabbings. The hospital has established an educational system led by consultants and regularly hosts trainees from around the world. Our team completed a 4-week observation and an 11-week trauma surgery training program at the hospital. During the training, the trauma unit managed 1,187 patients, including 516 stabbing and 236 gunshot cases, and performed 321 surgeries, including 168 emergency laparotomies and 21 thoracotomies. The program offered comprehensive training encompassing resuscitation room management, surgeries, and postoperative care, while integrating trainees into the team. South Africa exemplifies excellence in trauma training, underscoring the significance of ongoing international partnerships.

　　Background : Motor vehicle accidents (MVAs) and deaths have been decreasing due to advances in motor vehicle technology and emergency medicine. However, despite serving as a crucial safety measure, seatbelt injuries are encountered in clinical practice.

　　Methods : Nippon Medical School Chiba Hokusoh Hospital has been collecting data from patients and vehicles involved in MVAs since November 2009 in collaboration with Nihon University College of Engineering. This single-center retrospective study was conducted from November 2009 to May 2022. Inclusion criteria were patients injured in frontal collisions who consented to participate in the research. We sought to identify relationships between seatbelt use and abdominal solid/hollow organ injuries.

　　Results : Of 4,086 patients involved in MVAs, 491 patients were enrolled. Mean age was 49.5 ± 21.9 years, mean equivalent barrier speed was 36.9 ± 14 km/h, median Injury Severity Score (ISS) was 9, ISS 16+ was 33%, and 81% wore seatbelts. Abdominal solid organ injuries were significantly more frequent in patients that did not wear seatbelts than those that wore seatbelts (30% vs. 11%, p < 0.01). On the other hand, there were significantly more hollow organ injuries in patients who wore seatbelts (21% vs. 4%, p = 0.01).

　　Conclusion : Although seatbelts are important for safety, improvements are necessary.

　　A man in his fifties slipped and fell in a parking lot, hitting his head. He was taking two antithrombotic medications. The patient visited our hospital for headache. Physical examination revealed tenderness in the occipital area. CT revealed acute subdural hematoma and cerebral contusion. After admission, the patient exhibited disorientation, followed by aphasia and paralysis. Subsequent CT scans revealed exacerbation of intracranial lesions, prompting us to perform craniotomy on day 3. We had intended to start anticoagulant therapy once we determined that the risk of postoperative hemorrhagic complications was low, but the patient developed pulmonary thromboembolism and went into cardiac arrest temporarily on day 15. We performed resuscitation and the patient survived. We initiated anticoagulant therapy with heparin. The patient recovered with the therapy and was transferred for rehabilitation on day 61. Anticoagulant therapy should be considered in the early postoperative period to prevent venous thromboembolism after head injury surgery.

　　We report a case of a 41-year-old male who was injured in a traffic accident and transported to our hospital. Whole-body computed tomography (CT) revealed right pneumothorax, pneumopericardium, and intraperitoneal hemorrhage due to mesenteric injury. He developed hemorrhagic shock. Emergency laparotomy was performed to achieve hemostasis, and open abdomen management (OAM) was initiated. We determined that the pericardium and right pleural cavity were communicating ; therefore, right chest drainage was performed to treat his pneumopericardium and right pneumothorax. In the intensive care unit, the patient developed obstructive shock due to tension pneumopericardium. As OAM may have created communication between the pericardium and the intra-abdominal space, pericardium drainage was performed using an anterior parasternal approach rather than a subxiphoid approach. The patient recovered from his shock episode following the drainage procedure and was discharged home on day 52 following his admission to the hospital.

　　In recent years, the number of surgical trauma cases has decreased due to the reduction in traffic accidents and advances in non-operative management. Consequently, training trauma surgeons has become increasingly challenging. While simulation training with animals and donated bodies is conducted, accessibility remains limited due to the low number of events and participants. Although learning through surgical videos is widely used in the field of surgery and its usefulness has been reported, there are few surgical videos related to trauma surgery techniques. Enhancements in the training system for trauma surgery are necessary. We call on the Japanese Association for The Surgery of Trauma to create a database of online videos on trauma surgery. Consolidating surgical videos of trauma cases in a library and sharing techniques and strategies for the treatment of major trauma cases will be a useful reference for improving the skills of young surgeons. Although issues exist, such as consideration for patient privacy and increased workload due to video editing, trauma surgery education using surgical videos is a useful endeavor in the field of trauma.

　　An 85-year-old male was injured when his lower body was trapped under a rotary tiller of a tractor and crushed by the tilling claws while working in a field. He had an open wound of the left lower abdomen with evisceration, as well as open wounds in the left thigh and right lower leg. The center of the transverse colon and the distal part of the descending colon had both ruptured, and severe crushing of the left abdominal wall was observed. Left hemicolectomy, colostomy, and wound debridement were performed. The wound was managed using negative pressure wound therapy ; however, because the soft tissue for reconstruction was also severely damaged, we closed the ruptured abdominal wall wound on the left side using a flap reconstruction procedure from the left chest.

　　A 50-year-old male with multiple gunshot injuries underwent multiple surgeries on the day of admission, including surgery for spinal cord injury. After being shot in front of his home, he was brought to our hospital for emergency treatment. Contrast-enhanced computed tomography of his neck and lower extremities revealed right hemothorax and liver and spinal cord injury. After emergency laparotomy and transcatheter arterial embolization for the liver injury, the patient’s general condition stabilized in the intensive care unit, and he underwent spinal surgery on the same day. After postoperative rehabilitation, the patient was able to walk independently and was discharged for home. The approach for managing gunshot injuries involves stabilizing respiration and circulation with reliable hemostasis, followed by treatment to reduce functional impairment as early as feasible.

　　Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes.

Objective

To investigate the effectiveness and problems of prehospital tourniquet use in our hospital.

Methods

Thos was a single-center retrospective study. Subjects were trauma patients with an Injury Severity Score (ISS) of 9 or higher who were transported to our hospital between 2019 and 2022.

Results

A total of 853 trauma patients were included in this study. There were 194 upper- and 459 lower-extremity trauma cases. Five patients had a tourniquet applied, their median age was 57 years (range, 43 - 83 years), all were male, and they involved two upper- and three lower-extremity trauma cases. One of the five cases had arterial injury (peroneal artery injury). Complications caused by tourniquet use included deep vein thrombosis in one patient and insufficient pressure that contributed to venous hemorrhage in another patient.

Conclusion

While tourniquet use was effective, there were some associated complications. The duration of tourniquet use exceeded two hours in some cases, and this is an issue that needs to be improved.