BACKGROUND: Skull trepanation is an ancient art and has been recognized in many, if not most, primitive societies. Papua New Guinea came into contact with Europeans in the late 1800s and therefore it was possible for the art to be documented at a time when cranial surgery in Europe was still in its infancy. METHODS: A reviewof published articles and accounts of those who observed skull trepanation or spoke to those who had. Review of a video of trepanation as practised today in Lihir. FINDINGS: Richard Parkinson was a trader turned amateur anthropologist who was able to observe the surgical procedure being practised in Blanche Bay (New Britain). Trepanation was also witnessed by Rev. J.A. Crump in the Duke of Yorks. In New Britain the operation was performed for trauma but in New Ireland it was also employed on conscious patients for epilepsy or severe headache, particularly in the first five years of life. There was, however, a tendency to operate on frontal depressed and open fractures, rather than temporoparietal ones. Once the decision to operate was made the wound was irrigated in coconut juice and this was also used to wash the hands of the surgeon. Anaesthesia was not required as the traumatized patient was unconscious. The procedure is described and the tools included local materials such as obsidian, shark's tooth, a sharpened shell, rattan, coconut shell and bamboo. Of particular interest is the observation of brain pulsations and their relationship to a successful outcome. ASSESSMENT: The outcomes were good, in that 70% of patients were thought to survive, contrasting with a 75% mortality for cranial surgery in London in the 1870s. There is supporting evidence in that many trepanned skulls show evidence of healing and life long after the procedure was completed. Other societies have reported similar survival rates. The good outcomes may have been due to wise case selection as well as a high level of surgical skill following sound principles of wound debridement without necessarily being able to drain a haematoma.
Skull ; New ; Procedures ; Injury wounds ; Surgical aspects

The conventional management of scalp laceration has its drawbacks. Most patients complain of scalp itching, sticky hair and pain at the time of dressing change, because the washing of the hair is restricted and the wound is covered with gauze before the patients have their stitches removed. In this paper, we report the results of trial given to a new management method. The wound was exposed to the air two days after suturing and washing the hair was allowed at the same time. The trial involved 40 outpatients with scalp laceration. There were no complications of wound infection or delayed healing due to this method. And also most patients (90%) said they felt comfortable. Thus, as an alternative management of scalp laceration this method proved useful for comfortable wound treatment.
Scalp ; Laceration ; Injury wounds ; Hair ; Complications Specific to Antepartum or Postpartum

PURPOSE: Alcohol consumption is an important risk factor for injury. It is controversial, however, whether alcohol also has an effect on the severity of injury. We tried to evaluate the effect of alcohol on the severity of injury, especially on the severity of blunt injury due to traffic accidents, falls, collisions, and so on. METHODS: We used the ED-based injury registry in a regional emergency center. During two months, 831 victims were registered. We enrolled 397 patients who were over 15 years and had been injured by blunt trauma. We classified them into two groups by alcohol consumption. Positive alcohol consumption was defined as that positively confirmed by the victims or guardians, or that suspected on physical examination. The injury severity was measured by using the New Injury Severity Score, the Revised Trauma Score, the Trauma and Injury Severity Score (TRISS), the probability of survival of TRISS, and the International Classification of Disease 10th-version-based Injury Severity Score. RESULTS: Alcohol consumption was significantly larger in males than in females, in intentional injuries than in accidental injuries, in injury mechanisms other than traffic accident injuries, and in nighttime injuries than daytime injuries. However, the injury severity for the two groups was not significantly different. In the subgroup analysis, alcohol did not seem to affect the severity of injury due to any of the individual injury mechanisms. CONCLUSION: Alcohol consumption has no significant effect on the severity of blunt injuries.
Accidents, Traffic ; Alcohol Drinking* ; Classification ; Emergencies ; Female ; Humans ; Injury Severity Score ; Male ; Physical Examination ; Risk Factors ; Wounds and Injuries ; Wounds, Nonpenetrating*

PURPOSE: The purpose of this study is to show the correlation between Health-related quality of life (HRQOL) score and injury severity score (ISS) in patients with injury in emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 234 eligible injury patients who had visited our emergency center were enrolled in the study. HRQOL was assessed in 10 days after injury by Korean Short Form Health Survey- 36(KSF-36), Korean EuroQol 5 dimensions (KEQ-5D), and Korean Human Utility Index-3(KHUI-3). The severity of injury was measured by using the ISS. RESULTS: Of the 234 subjects, 149(63.7%) were men and 85(36.3%) were women, with mean(+/-SD) age of 46.1(+/-15.3) and mean ISS(+/-SD) of 4.54(+/-3.98). The KEQ-5D and KHUI-3 scores adjusted by ISS in patients with medical operation or hospitalization were significantly lower than those in patients without medical operation or hospitalization. All HRQOL scores except KSF-36 physical component summary (PCS) and general health (GH) score were significantly lower in patients group with high ISS than in patients group with low ISS. KEQ-5D and KHUI-3 had significant negative correlation with ISS (r=-0.58,-0.52). But there were no significant correlation between KSF-36 score and ISS. CONCLUSION: In this study, we observed that KEQ-5D and KHUI-3 scores in patients with injury were significantly correlated with ISS. However, to define the more definite feature of HRQOL in patients with injury, the study with more and large epidemiologic controlled injury group and detailed variable adjustment should be done.
Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitalization ; Humans ; Injury Severity Score* ; Male ; Quality of Life* ; Wounds and Injuries

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL) in patients with injury in the Emergency department, to compare that HRQOLs with normal control group, and to offer the results of this study as basic data on the HRQOL in Korean patients with injury, in the Emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 266 eligible injury patients who had visited our emergency center were enrolled in the study. The HRQOL was measured by using the Korean Short Form Health Survey-36 (KSF-36)and the Korean EuroQol 5 dimensions (KEQ-5D). The HRQOL was assessed at 10 days after injury. The severity of injury was measured by using the Injury Severity Score (ISS). RESULTS: Of the 266 subjects, 164 (61.7%) were men and 102 (38.3%) were women, with a mean (+/-SD) age of 42.8 (+/-15.2) and mean ISS (+/-SD) of 4.54 (+/-3.98). The KSF- 36 and KEQ-5D scores in patients with injury were significantly lower than those in the normal control group. The HRQOL scores of each group by cause of injury had significant differences in the KSF-36 MCS and the KEQ-5D utility index, but they had no significant differences in the KSF-36 PCS. Women were more likely to have poor HRQOLs than men, but no statistical significance was found. Patients with non-intentional injury and hospitalized were more likely to have poor HRQOLs than patients with intentional injury and discharged, but the statistical significance varied with the measurement tool. CONCLUSION: In this study, we observed that the HRLOQs in patients with injury were lower than those in healthy subjects. However, if more definite feature of HRLOQ in patients with injury are to be defined, a study with a large epidemiologic controlled injury group and with detailed adjustments of the variable is needed.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Injury Severity Score ; Male ; Quality of Life* ; Wounds and Injuries

We report the case of a patient with penetrating chest trauma (right chest) who had undergone a left pneumonectomy due to pulmonary tuberculosis 24 years ago. We performed an emergent thoracotomy, finding an opening of the penetrating wound in a lower-lobe basal segment of the right lung. A stapled tractotomy was performed along the tract. Bleeding control and air-leakage control was done easily and rapidly. The patient was discharged without any complications on the seventh day of admission. Tractotomy can be a good option for treating penetrating lung injuries in patients with limited lung function who need emergent surgery.
Foreign Bodies ; Hemorrhage ; Humans ; Lung Injury* ; Lung* ; Pneumonectomy ; Thoracotomy ; Thorax ; Tuberculosis, Pulmonary ; Wounds, Penetrating

We report the case of a patient with penetrating chest trauma (right chest) who had undergone a left pneumonectomy due to pulmonary tuberculosis 24 years ago. We performed an emergent thoracotomy, finding an opening of the penetrating wound in a lower-lobe basal segment of the right lung. A stapled tractotomy was performed along the tract. Bleeding control and air-leakage control was done easily and rapidly. The patient was discharged without any complications on the seventh day of admission. Tractotomy can be a good option for treating penetrating lung injuries in patients with limited lung function who need emergent surgery.
Foreign Bodies ; Hemorrhage ; Humans ; Lung Injury* ; Lung* ; Pneumonectomy ; Thoracotomy ; Thorax ; Tuberculosis, Pulmonary ; Wounds, Penetrating

PURPOSE: We tried to apply an Emergency-Departmentbased In-depth Injury Surveillance System designed on the basis of the International Classification of External Causes of Injuries (ICECI). METHODS: We registered prospectively all victims presenting with an injury from August 2004 to February 2005 at a local emergency center with 530 inpatient beds and 24 emergency beds. We evaluated the distribution and the proportion by injury-related factors and compared the severity by using the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), the International Classification of Disease-10-based Injury Severity Score (ICISS). RESULTS: The total number of cases was 2,994 and 58.4% of those involved male. Accidental injuries were much greater in number (88.2%) than intentional injuries (10.7%). By mechanism, falls, motor vehicle accidents, piercing/cutting/biting, burns, poisoning/chemical, and other blunt injuries accounted for 28.3%, 14.0%, 13.8%, 3.9%, 2.8%, and 21.5%, respectively, of all injuries. The most common activity was unpaid work (27.3%) and the most common place was a home/residence or institute (44.1%). By severity based on the NISS, mild (below 8 points), moderate (9 to 24 points), and severe (above 25 points) injuries accounted for 89.6%, 9.6%, and 0.8%, respectively, of all injuries. The ICISS and the NISS showed a strongly negative correlation (correlation coefficient= -0.656, p<0.001), and the ICISS and the RTS showed a strongly positive correlation (correlation coefficient = 0.518, p<0.001). CONCLUSION: The In-depth EDISS based on the ICECI was a useful tool for the surveillance of injury-related factors and was a feasible method for measuring and comparing injury severity.
Burns ; Classification ; Emergencies* ; Humans ; Injury Severity Score ; Inpatients ; Male ; Motor Vehicles ; Prospective Studies ; Wounds, Nonpenetrating

OBJECTIVEThe association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes.

METHODSA retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients?demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The management of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified.

RESULTSAmong the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98+/-15.21) years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS larger than 25 (LR equal to 8.5, P less than 0.05); (2) significant associated chest injury (AIS larger than 3, LR equal to 5.3, P less than 0.05) and (3) significant associated abdominal injury (AIS larger than 3, LR equal to 5.3, P larger than 0.05).

CONCLUSIONA blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.

PURPOSE: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. METHODS: A systematic literature review searched "liver trauma", "hepatic trauma", "conservative management", "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs; studies reported NOM complications together with those post-intervention; case reports; studies including less than 5 cases; studies not written in English; and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. RESULTS: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. CONCLUSION NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.
Abdominal Injuries/complications* ; Compartment Syndromes ; Humans ; Injury Severity Score ; Liver/injuries* ; Retrospective Studies ; Wounds, Nonpenetrating/complications*