J Trauma
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Ten patients with blunt heart rupture arrived in our emergency center alive during an 11-year period ending in 1984. Ages ranged from 19 to 65 years (mean, 35), and seven patients were male. Six patients presented with tamponade, three with hemorrhagic shock, and one with combined symptoms. ⋯ Seven patients survived. Three deaths were due to irreversible hemorrhagic shock, two secondary to heart injury, and one from an associated liver injury. Prompt pericardial window with subsequent median sternotomy was successful for patients presenting with tamponade and immediate thoracotomy for those bleeding into a pleural cavity.
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We present two cases of delayed, massive, life-threatening hemothorax due to intercostal hemorrhage in association with fractured ribs and severe blunt chest trauma (SBCT), a combination we have not seen described in the literature. Blunt chest trauma is not benign. Significant intrathoracic injuries are frequent although usually not life threatening. ⋯ However, rapid blood loss requires immediate open thoracotomy and surgical attention. Several days of observation in hospital may be required for patients with SBCT and fractured ribs even without any other obvious intra- or extra-thoracic injuries. Vigorous activity or chest physical therapy may be dangerous during the first several days after the injury.
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Pneumoperitoneum usually implies perforation of the gastrointestinal tract, although the tracheobronchial tree has been recognized as a source for free intraperitoneal air. We report a case of pneumoperitoneum resulting from tracheobronchial rupture following blunt chest trauma, which was successfully treated by surgical repair.
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Case Reports
An approach to curative effect of large autografts on adipose tissue in special parts with third-degree burns.
Burns involving face, hand, dorsum of foot and areas around joints are regarded as burns of special parts. Because of the structural characteristics we emphasize the importance of preserving subeschar adipose tissue and using large sheets of skin graft in these parts of body during the resurfacing procedures. Thirty-one cases with 56 sites of deep burns were observed. ⋯ We prefer grafting debrided facial wounds with sheets of skin according to regional units. The minimal width of circular grafts around ankle and wrist is discussed. For wrist, the recommended minimal width is 4 cm; for ankle, it is 5 cm.
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Most foreign bodies in the chest do their damage at the time of injury. While needle-like objects may migrate (6), delayed intrathoracic injury is rare. Delayed transthoracic penetration of the heart by a staple is reported, and is felt to be unique because acute hemopericardium resulted 30 days after the time of initial injury. The principles of recognition of pericardial tamponade, initial stabilization with periocardiocentesis, and immediate exploration are emphasized.