An Unusual Cervical Penetrating Wound Extended to the Right Pleural Dome

The solution of continuity of the tissues of the neck with rupture of the platysma muscle is called a cervical penetrating wound. The authors report a case of an unusual penetrating neck wound extended to the pleural dome by stabbing a psychiatric patient. They describe the diagnostic circumstances, the therapeutic approach and discuss data from the literature. It was a 26-year-old young woman, who was received in ENT for a penetrating neck wound with a stab wound following a suicide attempt. The diagnosis of a penetrating stab wound to the neck extending to the right pleural dome was retained. The exploratory cervicotomy with the extraction of the foreign body found a knife blade penetrating the anterior base of the right side of the neck to the right pleural dome, sparing the noble vasculo-nervous and aero-digestive organs of the neck. The postoperative course was simple and the evolution was favourable. This unusual penetrating wound of the neck is spectacular and remarkable for the absence of involvement of noble organs despite the involvement of the pleural dome. However, it remains a concern in psychiatric patients and requires multidisciplinary management and systemic management in order to avoid recurrence.

Diagnosis and treatment of penetrating wounds through the anorectum and urinary bladder or posterior urethra

Penetrating wound of the anal canal is relatively rare, which is often complicated with injuries of the rectum, urinary bladder or posterior urethra. Misdiagnosis and improper treatments of the disease may lead to pelvic abscess, anal stenosis, fecal incontinence, or rectovesical fistula. From 1985 to 2004, 16 patients with penetrating wounds through the anorectum and urinary bladder or posterior urethra were treated in our hospital.

开放性喉外伤的急救与创伤修复

开放性喉外伤是一种危重急症，常可引起呼吸困难、大出血、休克等症而危及生命。笔者对我院1991年6月-2007年6月16年间救治的29例开放性喉外伤患者的临床资料进行分析，报道如下。

Diagnosis and treatment of penetrating anorectal wounds

Objective： To research the diagnosis and effective treatment of penetrating anorectal wounds. Methods： Retrospective analysis was done in 16 cases of penetrating anorectal wounds from 1985 to 2004. Dehridement and suture of anorectal and vesical wounds, effective diversion of fecal and urinary stream and sufficient presacral drainage were performed in all cases. Results ： All the 16 cases were cured. Among them, 2 cases with infection in presacral space were cured by sufficient drainage after operation, one case was cured by secondary repair after anal sphincter was repaired unsuccessfully and one case with rectovesical fistula was cured with conservative treatment. None of them suffered from complications such as anal stenosis, dysuria or importence etc. Conclusions： For penetrating anorectal wound, to master early recognition of concomitant injures, to select appropriate surgical intervention and to strengthen perioperative treatment are the keys to improve the curative effects.

Outcome of penetrating cardiac injuries in southern Iran, Shiraz

Objective： Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. Methods： From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. Results： The study consisted of 37 patients, including 1 gunshot wound （2.7%）, 35 stab wounds （94.6%） and 1 （2.7%） shotgun wound. The overall survival rate was 76% （28 in 37） and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed sig- nificant correlation between mortality and electrocardio- graphic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type （gunshot more than stab wound）. Conclusion： Our results show that injury mechanism and initial cardiac rhythm are significant predictors of out- comes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.

Video-assisted thoracoscopic surgery for penetrating thoracic trauma

Purpose： For penetrating thoracic trauma, there is no consensus on whether operative exploration or conservative treatment is better. In this study, we compared the clinical effect of video-assisted thoracoscopic surgery （VATS） and thoracotomy on the patients with penetrating thoracic trauma. Methods： From January 2000 to December 2010, 123 patients with penetrating thoracic trauma were treated in Affiliated Hospital of Chengdu University. Based on the inclusion criteria, 80 patients were enrolled and randomly assigned into VATS and thoracotomy group. Results： The operation time, amount of bleeding and drainage in VATS group were all lower than traditional operation （p 〈 0.05）. Conclusion： The results indicate that VATS has the merits of shorter operation time, non-blind area, exact surgical path and less bleeding comparing with traditional operation.

Surgical management of penetrating pelvic trauma： a case report and literature review

High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, geni- tourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suf- fering a collision at night with a deformed steel bar penetrat- ing into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility ofmultiorgan damage to intrapelvic struc-tures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection.

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma： a case report

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.

Nail penetrating trauma： a rare cause of vesicovaginal fistula

Vesicovaginal fistula （VVF） may be caused by prolonged obstructed labor, gynecologic, urologic, or other pelvic surgery, malignancy, radiation, infection and trauma. Here we report a case of VVF caused by nail penetrating trauma in a young woman with genital bleeding after first intercourse. This is a rare etiology of VVF. We also explain the operative technique used to repair the fistula.

Abscess formation in vertebral canal and presacral area following penetrating injury of rectum and sacral verte- bra by a steel rod

Penetrating injury to the rectum, verte- bral body and spinal cord by a steel rod is a rare condition. Treatment of this kind of injury is very challenging. Rectal injury requires repair and fecal diversion, while debride- ment of the spine is difficult, especially when the injury site is very long. Here we report a case of penetrating injury of rectum and sacral vertebra by a steel rod after falling onto the ground from 1 m height. The abscess cav- ity was irrigated with 3% hydrogen peroxide and physio- logical saline repeatedly. The bony canal was carefully debrided, curetted and bony fragments were removed. Spinal irrigation and drainage lasted for 2 months and sen- sitive antibiotic （amikacin sulfate） was given 7 days after surgery, but abscess was still formed in the vertebral canal. At 6-month follow-up, the patient was paralyzed without any neurological improvement, and the pain in low back and lower limb still continued.

Unusual management of thoracoabdominal impalement injury to the right hemiliver and diaphragm

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal im- palement injury associated with major liver and diaphrag- matic injuries. We successfully treated the impalement in- jury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a col- lection of fluid in the abdominal cavity. The conservativemanagement plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a pa- tient with less invasive techniques yielded a good outcome. This management option may be considered as an alterna- tive for open surgery for hemodynamically stable patients in experienced centres.