In blunt abdominal trauma, the abdomen may be compressed and crushed without disruption of the skin, without external bruising, and yet extensive and fatal internal injuries may be present. The penetrating wounds are especially dangerous because of the possibility of grave injury to internal organs or major blood vessels. The majority are homicidal injuries: suicide by stabbing, or accidental stabbing, is infrequent. The abdominal injuries usually coexist with other-site injuries, especially with chest injuries. The homicide and the suicide often aim at the heart, in consequence wound the left side of the chest or upper abdomen. This review is discussed on the mechanism of the blunt and penetrating abdominal injury, types of injury, and significance of medicolegal aspects of the abdominal trauma.
Abdomen* ; Abdominal Injuries ; Blood Vessels ; Heart ; Homicide ; Skin ; Suicide ; Thoracic Injuries ; Thorax ; Wounds and Injuries ; Wounds, Nonpenetrating* ; Wounds, Penetrating

OBJECTIVETo study the early change of serum nitric oxide (NO) after acute heat exposure with trauma and the effect of NO on mean arterial pressure (MAP), thus to provide theoretical basis for studying the mechanism of NO effect in acute stress.

METHODSThe rabbit model of acute heat exposure combined with trauma was established. The animals were divided into four groups, including control, trauma, hyperthermia and hyperthermia combined with trauma. The levels of NO were measured at different time points: 0 h, 1 h, 2 h and MAP was monitored throughout the whole experiment.

RESULTSThe concentration of NO declined at first and then increased at 1 h or so after acute heat exposure and trauma. The levels of NO in hyperthermia with trauma group at 1 h, 2 h were (42.75 +/- 8.24), (59.54 +/- 9.05) micro mol/L respectively (P < 0.05), while those in control group were (56.63 +/- 3.79) and (55.22 +/- 7.15) micro mol/L, the difference at 1h between two groups was significant (P < 0.05). Under the circumstance of hyperthermia and trauma, the level of MAP declined to the lowest point at 60 - 70 min and then showed a transient rise, after that, the level declined rapidly.

CONCLUSIONSAt the early stage of acute heat exposure and trauma, the concentration of serum NO declined at first and then increased, and had certain relationship with the change of MAP.

Animals ; Blood Pressure ; Cytokines ; biosynthesis ; Hot Temperature ; Male ; Nitric Oxide ; blood ; Rabbits ; Wounds and Injuries ; blood ; physiopathology

PURPOSE: To evaluate the serious effects of a paint gun injury and to determine the proper treatment. MATERIALS AND METHODS: The authors reviewed 30 cases of paint gun injuries of the hand that were treated from March, 1990 to September, 2000. We extended the original wound and removed the paint as soon as possible. The wound was left open, and debridementrepeated and delayed wound closure performed. The authors evaluated the results according to the Strickland evaluation method, and analysedthe results with respect to treatment delay and extent of injury. RESULTS: Delayed treatment, invasion of the paint along the neurovascular bundle and extensive injury resulted in a poor outcome. Amputationwas inevitable in 4 cases in which treatment had been delayed or when blood vessels had been invaded by the paint. CONCLUSION: Paint gun injury should be considered an emergency requiring immediate debridement. The surgeon should warn the patient that even after proper treatment, poor outcome can result.
Blood Vessels ; Debridement ; Emergencies ; Hand Injuries* ; Hand* ; Humans ; Paint ; Wounds and Injuries

BACKGROUND: This study investigated the clinical usefulness of an autotransfusion of drained blood using postoperative wound drainage and a reinfusion system to reduce the allogenic blood transfusion without complications. METHODS: Eighty patients were allocated randomly to either a control group using a standard drainage system or an autotransfusion group using postoperative wound drainage and a reinfusion system. The collection period was 12 h, and the drainage blood retransfused after 6 h, or a maximum of 500 ml of blood was collected after connecting the reinfusion system. Immediately before reinfusion, blood samples were taken from the reinfusion system and analyzed for the functional and metabolic status of the drained blood and compared with the preoperative values of patient. The hemoglobin level, blood loss, allogenic blood requirement and transfusion-related complications were assessed. RESULTS: The drained blood had lower hematological values, a prolonged PT and aPTT, a lower fibrinogen, and metabolic acidotic status than the preoperative values of the patients. There were no significant differences in the amount of blood loss compared with the control group. However, the autotransfusion group required significantly less allogenic blood (almost 20% less) without significant complications. CONCLUSIONS: Autotransfusion by reinfusion with drained blood in bilateral total knee arthroplasty reduces the allogenic blood requirement without significant complications.
Arthroplasty* ; Blood Transfusion ; Blood Transfusion, Autologous* ; Drainage ; Fibrinogen ; Humans ; Knee* ; Wounds and Injuries

PURPOSE: Many clinical trials have shown the effectiveness of platelet releasate on chronic wounds. However, a large volume of blood must be aspirated from a patient and a platelet separator is required. Here, we hypothesized that platelet concentrate obtained from a blood bank (PCBB) would be also effective at stimulating wound healing. The purpose of this study was to investigate the effectiveness of PCBB on accelerating healing of diabetic wounds in vivo. METHODS: Round wounds of 5mm diameter were made at four sites(two wounds on the left and two on the right side) on the backs of nine diabetic mice. Three hundred million platelets suspended in 0.05ml fibrinogen were dispersed on each wound on left sides. Same amount of fibrinogen without platelets was dispersed on right side control wounds. Thereafter, 0.05ml thrombin was applied to the each wound. Ten days after wound treatment, healed wounds were excised and the extent of wound healing in each group was compared. RESULTS: Quantitative histologic analysis of epithelial gap distances revealed that PCBB treatment had greatly accelerated wound healing. Mean epithelial gap distances for PCBB treated and control wounds were 2.5x0.6mm and 3.6x0.5mm, respectively(p<0.05). CONCLUSION: Our results suggest that PCBB has potential to accelerate the healing of diabetic wounds.
Animals ; Blood Banks* ; Blood Platelets* ; Fibrinogen ; Humans ; Mice* ; Thrombin ; Wound Healing ; Wounds and Injuries*

PURPOSE: Many clinical trials have shown the effectiveness of platelet releasate on chronic wounds. However, a large volume of blood must be aspirated from a patient and a platelet separator is required. Here, we hypothesized that platelet concentrate obtained from a blood bank (PCBB) would be also effective at stimulating wound healing. The purpose of this study was to investigate the effectiveness of PCBB on accelerating healing of diabetic wounds in vivo. METHODS: Round wounds of 5mm diameter were made at four sites(two wounds on the left and two on the right side) on the backs of nine diabetic mice. Three hundred million platelets suspended in 0.05ml fibrinogen were dispersed on each wound on left sides. Same amount of fibrinogen without platelets was dispersed on right side control wounds. Thereafter, 0.05ml thrombin was applied to the each wound. Ten days after wound treatment, healed wounds were excised and the extent of wound healing in each group was compared. RESULTS: Quantitative histologic analysis of epithelial gap distances revealed that PCBB treatment had greatly accelerated wound healing. Mean epithelial gap distances for PCBB treated and control wounds were 2.5x0.6mm and 3.6x0.5mm, respectively(p<0.05). CONCLUSION: Our results suggest that PCBB has potential to accelerate the healing of diabetic wounds.
Animals ; Blood Banks* ; Blood Platelets* ; Fibrinogen ; Humans ; Mice* ; Thrombin ; Wound Healing ; Wounds and Injuries*

Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Blood Platelets ; Blood Transfusion ; Hip ; Humans ; Suction* ; Wounds and Injuries

In order to investigate the correlation between traumatic servity and blood cAMP and cGMP levels in the patients with acute trauma and its clinical significance, 120 cases of trauma were randomly selected and divided into 4 groups (n = 30 in each group): mildly traumatic group (ISS < or = 9), moderately traumatic group (ISS = 10-16), severely traumatic group (ISS = 17-25) and dangerously traumatic group (> 25). The cAMP and cGMP levels were assayed in sera, leucocytes and platelets respectively in 6 h and 24 h after trauma. The results showed that cAMP and cGMP levels were elevated significantly in sera and platelets (P < 0.05 or P < 0.01), meanwhile cGMP levels in leucocytes (P < 0.05). It was concluded that cAMP and cGMP might play an important role in traumatic stress, participate in the cellular signal transducation and promote the immune function of leucocytes and the coagulation founction of platelets. Serum cAMP and cGMP levels were upregulated correspondingly as ISS increased, and positively correlated to the traumatic severity.
Blood Platelets/metabolism ; Cyclic AMP/*blood ; Cyclic GMP/*blood ; *Injury Severity Score ; Leukocytes/metabolism ; Wounds and Injuries/*blood

OBJECTIVE: The purpose of this study is to investigate the elevated blood glucose levels in the postoperative period are associated with an increased risk of deep wound infection in diabetic individuals undergoing lumbar spine surgery. METHODS: Of 2896 patients who underwent lumbar spine operations by one surgeon between 1993 and 2002, 329(11.4%) were diabetics. The rate of deep wound infections in diabetic patients was 6.4%, versus 3.2% for nondiabetics. 152 patients had their operation before implementation of the protocol and 177 after implementation. Charts of the diabetic patients were reviewed. Mean blood glucose levels were calculated from documented results of finger-stick glucometer testing. RESULTS: Twenty-one diabetic patients suffered deep wound infection. Infected diabetic patients had a higher mean blood glucose level through the first 2 postoperative days than noninfected patients(230+/-6.9 versus 175+/-3.8mg/dL; p<0.003) and had a long operation time(216+/-57.9 versus 167.5+/-42.2 minute; p<0.05). Multivariable logistic regression showed that mean blood glucose level for the first 2 postoperative days, long operation time, and use of the instrumentation(p<0.02) were all related predictiors of deep wound infection. Institution of a protocol of postoperative continuous intravenous insulin to maintain blood glucose level less than 200mg/dL was began in september 1997. This protocol resulted in a decrease in blood glucose levels for the first 2 postoperative days and a concomitant decrease in the proportion of patients with deep wound infection, from 8.3%(11/132) to 5.1%(10/195) (p<0.02). CONCLUSION: The incidence of deep wound infection in diabetic patients is reduced after implementation of a protocol to maintain mean blood glucose level less than 200mg/dL in the immediate postoperative period.
Blood Glucose ; Glucose* ; Humans ; Incidence ; Insulin ; Logistic Models ; Postoperative Period ; Spine* ; Wound Infection* ; Wounds and Injuries*

Four patients with soft tissue defects around the ankle joint were covered with peroneal artery perforator-based propeller flaps. Using color Doppler sonography, the flap was designed by considering the location of the perforator and soft tissue defects. The procedure was then performed by rotating the flap by 180o. Additional skin graft was required in a patient due to partial necrosis, and delayed wound repair was performed in another patient with poor blood circulation at the distal part of the flap. The remaining patients did not have any complications and results were considered excellent. Good outcomes were eventually obtained for all patients.
Ankle Joint* ; Arteries* ; Blood Circulation ; Humans ; Necrosis ; Skin ; Transplants ; Ultrasonography, Doppler, Color ; Wounds and Injuries