Clinical treatment of exposed skull injuries becomes extremely challenging. The current treatment methods for exposed skull injuries are mainly surgical treatments. However, these treatments are not suitable for elderly patients who cannot tolerate anaesthesia. This research aimed to assess the effectiveness of platelet-rich gel (PRG) as a non-surgical option for repairing exposed skull injuries. In this study, twelve patients who presented to our hospital with scalp defects between September 2018 and March 2022 were included. Patients were evaluated before and three days after treatment using the Visual Analog Scale (VAS) score, inflammatory markers, and topical skin temperature. Additionally, the length of the platelet-rich gel, number of dressing changes, wound-healing time, local scarring, and hair growth were recorded. The average wound area was 17.08 SD5.49 cm 2 . The platelet-rich gel exhibited a length of 3.09 SD0.09 cm and showed a significant increase in platelet concentration by a factor of 2.43 SD0.07. all 12 patients achieved complete healing, requiring average number of 8.3 SD2.0 dressing changes and resulting in an average wound healing time of 25.0 SD5.8 days. There were no statistically significant differences in the Visual Analog Scale scores, inflammatory markers, or topical skin temperatures before and after treatment. Follow-up assessments conducted 4–10 months after treatment revealed minimal local scars and sparse hair growth. The one-step preparation of platelet-rich gel in reconstructing scalp defects is a simple, safe, and effective non-surgical method. Its advantages include speedy preparation, painless treatment, and small local scars.

Reconstruction of scalp defects is a complicated and challenging procedure for reconstructive surgeons. This retrospective observational study assessed the effectiveness of using platelet-rich gel (PRG) versus the external tissue expansion technique (TET) in reconstructing scalp defects. The clinical data of 24 patients with scalp defects treated with PRG or external TET were collected from September 2018 to March 2022. Data on the wound characteristics, wound healing time, cost of treatment, visual analog scale, and observed wound healing status were collected. The mean wound healing times in the PRG and TET groups were 25.00 ± 5.77 and 13.58 ± 9.68 days, respectively (P < .05). The PRG group was significantly more cost-effective than the TET group (P < .05). TET treatment significantly increased patients' postoperative pain, which decreased over time (P < .05), while PRG treatment caused no significant change in pain (P > .05). The 2 groups showed no tissue depression or color change after wound healing at follow-up, but the hair growth in the TET group was significantly better than that in the PRG group (P < .05). Compared with TET treatment of scalp defects, PRG is not only simple and painless but also has a low treatment cost and, more importantly, does not involve the risk of surgery and anesthesia. However, using TET to treat scalp defects requires the careful selection of appropriate cases.

The duodenum is mostly a retroperitoneal structure, composed by 4 segments (D1-D4) and surrounded by other vital organs like pancreas or great vessels. Injuries to this organ are rare and difficult to diagnose, with an incidence of 1–5% in cases of abdominal trauma. The most common causes of duodenal injuries are gunshot wounds and stabbing. Duodenal injuries are often associated with other organ injuries, thus delaying diagnosis in some cases and increasing the risk of complications. When diagnosed at optimum timing, it can be treated with relatively low mortality rates. Great number of repair techniques exist and the treatment of choice depends on the surgeon’s experience and hemodynamic stability of the patient, with the goal of preserving life and preventing a major complication such as leak or fistula. Outcomes are good, and the prognosis is tightly ligated to associated injuries, thus high index of suspicion and applying ATLS and surgery trauma principles are essential.

BACKGROUND The number of patients with bronchial trauma (BT) who survived to hospital admission has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients, whose diagnosis is frequently delayed. AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs, and to elaborate the differences between them. METHODS All patients with BTs during the past 15 years were reviewed, and data were retrospectively analyzed regarding the mechanism of injury, diagnostic and therapeutic procedures, and outcomes. According to the injury mechanisms, the patients were divided into two groups: Blunt BT (BBT) group and penetrating BT (PBT) group. The injury severity, treatment procedures, and prognoses of the two groups were compared. RESULTS A total of 73 patients with BT were admitted during the study period. The proportion of BTs among the entire cohort with chest trauma was 2.4% (73/3018), and all 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group, and the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group (n = 38) and 34.3% in the PBT group (n = 35). In the BBT group, a delay in diagnosis for over 48 h occurred in 55.3% of patients. In the PBT group, 31 patients underwent emergency thoracotomy due to massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) and 5.7% (2/35) in the BBT group and PBT group, respectively (P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations. CONCLUSION The difference between blunt and penetrating BTs is obvious. In BBT, patients generally have no vessel injury, and the diagnosis is easily missed, leading to delayed treatment. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax, and delays in diagnosis are infrequent. The leading cause of death is hemorrhagic shock.

Biomechanical changes caused by structural foot deformities predispose patients to plantar ulceration. Plantar ulcer recurrence often leads to osteomyelitis, which is more commonly observed in patients with diabetes. Once the infection of diabetic foot ulcer (DFU) spreads and is complicated by osteomyelitis, treatment becomes more complicated and difficult. Osteomyelitis treatment remains challenging because of low drug concentration within the tissue caused by poor circulation and inadequate localized nutrition. Moreover, tissues around plantar ulcers are fewer and are thin, making the formation of granulation tissues difficult due to elevated plantar pressure. Furthermore, the skin around the wound is excessively keratinized, and the epidermis is hard to regenerate. Meanwhile, skin grafting at that site is often not successful due to poor blood circulation. Therefore, it is technically challenging to manage diabetic pressure plantar ulcer with osteomyelitis and prevent its recurrence. Here, we present a case of chronic DFU complicated by osteomyelitis due to foot deformity. The ulcer was successfully healed using advanced wound repair technology comprising of surgical bone resection, vancomycin-loaded bone cement implant, negative-pressure wound therapy, and autologous platelet-rich gel. Subsequently, preventive foot care with custom-made offloading footwear was prescribed. The plantar ulcer did not recur and improvement in biomechanical parameters was observed after the intervention. This case represents an effective and comprehensive management strategy for limb salvage and prevention in patients with complicated foot conditions.

Objective To study the early diagnosis,surgical treatment options,prevention and management of complications in patients with duodenal trauma.Methods All patients with duodenal trauma treated operatively from January 2009 to December 2018 were studied retrospectively.Factors including sex,age,cause of injury,AAST grading,diagnostic method,operative procedure,therapeutic effectiveness,complications,and factors related to death were analyzed.The "double-tube gastrostomy" technique consisting of duodenal decompression and jejunal feeding as recommend by the authors were used in severe cases.Results Blunt trauma occurred in 66 of 86 patients (76.7％).The diagnosis of duodenal trauma was made preoperatively based on abdominal signs,peritoneocentesis,and imaging in 32 patients (37.2％).The remaining 54 patients (62.8％),with duodenal injury was detected during emergency laparotomy.All the 86 patients underwent surgical intervention which included simple suturing,pedicled jejunal flap,segmental resection and anastomosis,Roux-en-Y duodenojejunostomy,diverticularization,and Whipple's procedure using the principle of Damage Control Surgery (DCS).Postoperative morbidity occurred in 15 patients (17.4％).There was a high incidence of duodenal (or pancreatic,biliary) fistulae.The overall mortality rate was 12.8％ (in 11 patients).The causes of deaths were mainly massive bleeding and poly-trauma.Conclusions To decrease morbidity and mortality rates,early diagnosis and surgical intervention were critical.The choice of surgical treatment procedures should be based on the duodenal trauma grading and whether there were associated injuries.For patients with a combined pancreaticoduodenal trauma,DCS is a wise procedure to adopt.The double-tube gastrostomy technique as recommended by the authors is beneficial to severe cases in decreasing the incidences of postoperative duodenal and jejunal obstruction.

The development of trauma surgery in China has made great achievements during the past 30 years.The urban trauma centers established in Chongqing,Beijing,Wuhan and Hangzhou play a leading and exem-plary role in the discipline construction of trauma care.The trauma care system of"China model"also has been ini-tially established,the theoretical basis and an academic platform for trauma surgery have been set up,and the basic theories and technical principles,key theories and core technology of trauma care have been summarized.The trau-ma care ability,especially for severe multiple injuries,have been improved significantly.However,a complete na-tional network of trauma care system has not yet been established in China,and the overall treatment level for trauma is still lagging behind the developed countries.In order to achieve the goal of"healthy China 2030",to increase the average life expectancy to 79 years by year 2030,the development of trauma surgery may face great historical oppor-tunities and challenges.

The early treatments after fasciotomy of compartment syndrome mainly focused on metabolic disorder caused by ischemia-reperfusion injury,including hypokalemia,metabolic acidosis,rhabdomyolysis,and myoglobinuria.There was no evidence for conventional anticoagulation after surgery due to the risk of bleeding.Continuous negative pressure drainage was useful in reducing tissue damage caused by ischemia-reperfusion and improving tissue blood supply.In addition,hyperbaric oxygen was also effective in preventing tissue ischemia and necrosis after ischemia-reperfusion injury.In recent years,as the representative closure method of incision of fasciotomy,the "shoe lace technique" has been widely used in clinical practices,together with derived commercial products,the incidence of incision complications was effectively reduced.The author reviewed the progress in management of postoperative factors related to fasciotomy of compartment syndrome so as to provide reference for improving clinical curative effect.

Objective To summarize treatment methods for severe liver trauma associated with trauma-in-duced coagulopathy .Methods The clinical data of 32 sustained severe liver trauma patients associated with trau-ma-induced coagulopathy were collected from Feb .2010 to Apr.2016 in Chongqing Emergency Medical Center . There were 23 males and 9 females with an average age of 37.4(15-84) years.Seventeen cases (56.3%) were in-jured from road traffic accidents ,10 were from high falling/falling,3 were from crushing and 2 were from other causes . The methods of damage control resuscitation and treatment results were analyzed retrospectively .Results All the 32 cases had multiple injuries .The rapid assessment of the severity of injury was done in admission according to the principle of"CRASH PLAN",while the establishment of venous access and coagulation function ,cross matching and other tests were performed ,and the cases were resuscitated according to the principle of damage control resuscitation (DCR).Preoperative coagulation dysfunction occurred in 19 cases.Massive blood transfusion was achieved in 22 cases by fresh frozen plasma(FFP),packed red blood cells(PRBC) in the ratio of 6-10u, respectively and 10u of cryoprecitation.Liver trauma was grade Ⅳ in 20 cases,and was grade Ⅴin 12 cases.Damage control surgery in-cluding debridement hepatectomy was performed in 22 cases and improved peri-hepatic packing was performed in 13 cases.The operative time was 30min-1.5h.In this group,24 cases were survived ,and the overall mortality rate was 25%(8/32).Six (18.8%,6/32)cases died of liver injury with or without complications .Besides associated inju-ries inside and outside the abdomen , exsanguination due to liver trauma and coagulopathy was the main cause of death.Conclusion Trauma-induced coagulopathy would easily develop in patients with liver trauma of grade Ⅳand gradeⅤ.DCR is the main protocol in treating such patients .Improved perihepatic packing and debridement hepatectomy are the main damage control measures in treating severe liver trauma associated with trauma -induced coagulopathy .

Objective To evaluate the therapeutic methods and effect of pre-hospital and in-hospital inte-grated treatment for severe crush injuries of extremities . Methods The clinical data of 49 patients with severe crush injuries of extremities from May 2008 to Jul.2015 in Chongqing Emergency Medical Center was retrospectively studied.There were 44 males and 5 females,with age ranging from 19 to 82 years (average,43.7 years).There were 5 cases of earthquake injury ,20 cases of traffic accident injury ,17 cases of mining accident injury ,and 7 cases injured by other causes .Injured sites of crushes were as follows: shoulder and upper limbs in 8 cases ( 16.3%) , pelvic and lower limbs in 41 cases(83.7%).Thirty-two cases(65.3%) were associated with fractures and disloca-tion of pelvis and joints,and 44 cases were associated with multiple injuries (89.8%).Results Pre-hospital time was 35min-49h.Venous pathway was established and infusion was applied in 19 cases during on-the-scene rescue and tourniquet was applied in 31 cases (63.3%).Decompressive fasciotomy was performed in 1 case and amputa-tion was performed in 1 case during on-the-scene rescue .Electrocardiogram monitoring was performed in all cases after decompression.In-hospital therapeutic measures included vacuum sealing drainage (VSD) in 14 cases after debridement and 17 cases with decompressive fasciotomy . The effective rate of VSD was 96.8%( 30/31 ) and no case was amputated in this group .The incidence rate of crush syndrome (CS) was 57.1%(28/49),of which 11 cases (22.4%) were combined with hyperkalemia ,and 8 cases with renal failure.Eight cases were treated with ventilator assisted therapy and 8 cases were treated with continuous renal replacement therapy ( CRRT ) . At the end,31 cases(63.3%) were cured,13 cases(26.5%) were improved,and 5 cases(10.2%) were uncured,which included 3 cases ( 6.1%) of amputation and 1 death case ( 2.0%) died from failed cardiopulmonary resuscitation due to hyperkalemia .Conclusion Tourniquet and electrocardiogram monitoring should be emphasized in pre-hos-pital treatment of severe crush injuries of extremities .Application of VSD in in-hospital treatment can reduce the in-cidence rate of amputation of severe crush injuries of extremities .

Objective To summarize managing methods for pelvic fractures associated with trauma induced coagulopathy.Methods A retrospective analysis was done on the clinical data of 423 cases of severe pelvic frac-tures treated by damage control surgery(DCS) and damage control resuscitation(DCR) from Jan.2007 to Dec. 2015.Another 198 cases,as the control group,were treated without DCS or DCR from Jan.1995 to Feb.2003.And the former was as the study group.The control group underwent definitive operation initially.The study group un-derwent internal iliac arteries devascularization in the first place, followed by surgical interventions for hemostasis and blocking contamination.Patients were then transferred to ICU for further resuscitation based on DCR protocol. Definitive operations were performed only when patients became stable.Results Traumatic induced coagulopathy developed in 52 patients in the control group,including 23 deaths among them.And the mortality was 44.23%(23/52) .In the study group,there were 382 cases with ongoing hemorrhage,and trauma induced coagulopathy occurred in 86 cases.A total of 382 patients with ongoing hemorrhage underwent emergent internal iliac arteries devascular-ization,206 of whom received pelvic external fixation.In patients associated with visceral injuries,laparotomy was performed in accordance with DCS.Abiding by the principle of damage control resuscitation,hemostatic resuscitation measures were performed,and blood products and coagulation factor were transfused in the first place.The definitive surgery was performed when vital signs got stable after further resuscitation in ICU.The main complications included 17 cases of sepsis of pelvic and abdominal cavity,22 cases of abdominal compartment syndrome,12 cases of fat em-bolisation syndrome,and 30 cases of deep venous embolism.The death rate of the study group was 22.09%(19/86).The main cause of death was hemorrhagic shock.Conclusion Trauma induced coagulapathy would easily develop when pelvic fractures are severe.It would be greatly helpful in treating such patients with DCR protocol, combined with internal iliac arteries devascularization and pelvic external fixation to control hemorrhage,and the sur-vival rate will be improved obviously.

Trauma-induced coagulopathy( TIC) is coagulation dysfunction induced by severe trauma,and is the result of multiple independent but interacting mechanisms.It is a great challenge in the treatment of trauma.Ear-ly identification of coagulopathy is dependent on awareness of high risk factors and examination of coagulative func-tion.Effective haemostasis, damage control resuscitation and the management of “lethal triad” are the main treat-ment strategies of TIC.

Objective To analyze the clinical effect of vacuum sealing drainage (VSD) on skin and soft tissue injury in elderly patients.Methods A total of 75 patients with severe skin and soft tissue injury who met the inclusion criteria were enrolled in this study.They were divided into two groups based on admission dates:the observation group (n =40,receiving VSD treatment,oddnumber date admission) and the control group (n=35,receiving routine dressing changes,even number date admission).The clinical indexes including pain score,wound healing time,infection rate and complications were analyzed and compared between the two groups.Results There was a significant difference in the average length of hospitalization between the two groups (21.3 days vl 30.7 days,t=7.60,P=0.0000).The infection rate was lower in the observation group than in the control group (12.5％ or 5/40 vs.54.3％ or 19/35,x2=13.12,P=0.0003).The incidence of complications was lower in the observation group than in the control group (15.0％ or 6/40 vs.42.9％ or 15/35,x2=5.87,P=0.0154).There were no deaths in the observation group,but one patient died from acute pulmonary embolism in the control group during hospitalization.Conclusions VSD can alleviate pain,reduce the infection rate,shorten the length of hospitalization and decrease bedridden complications in elderly patients with severe skin and soft tissue injury,and has valuable applications in clinical practice.

目的：探讨损伤控制外科（DCS）在骨盆骨折合并毗邻脏器伤早期救治中的实施方法和疗效。方法对2008年2月至2013年9月在重庆市急救医疗中心创伤科应用 DCS 方法救治骨盆骨折合并毗邻脏器伤21例的临床资料作回顾性分析。结果初期手术行双侧髂内动脉结扎11例，栓塞4例，骨盆填塞5例；外固定支架使用18例；膀胱造口11例，尿道会师2例；腹膜外直肠及肛管伤做结肠造口4例。本组死亡2例（9．5％）。死因为失血性休克及脑伤各1例。并发症7例，包括深静脉血栓形成2例，直肠膀胱瘘、骨盆感染、腹腔间室综合征、尿道狭窄、下肢短缩各1例。结论髂内动脉断血、稳定骨盆、骨盆填塞是 DCS在骨盆骨折合并毗邻脏器损伤早期救治中控制出血的三大措施；膀胱造口和结肠造口，是急诊治疗时常采用的有效方法；创伤专科化能提高骨盆骨折合并毗邻脏器伤的救治成功率。

Objective To investigate the cause and therapy of severe intra-abdominal infection following abdominal injuries .Methods The clinical data of 37 cases of severe abdominal infection following abdominal inju-ries in our hospital from Feb .2006 to May 2013 were studied retrospectively .There were 31 males and 6 females, with mean age of 37.25 years old (ranged from 17 to 73 years old).The injury site,causes,abdominal infection causes,treatment methods and complications were analyzed .Results For all of the patients,the intra-abdominal infection was diagnosed by physical examination ,abdominal paracentesis ,ultrasound and CT scan .The causes of in-fection included miss-diagnosis in 13 cases during initial exploratory laparotomy ,inappropriate primary surgical treat-ment in 9 cases,delayed rupture after gastrointestinal contusion in 7 cases.Gastrointestinal repair or resection was performed in 7 cases,subphrenic drainage in 8 cases,percutaneous puncture and catheter drainage of intra-abdominal abscess in 5 cases,proximal colostomy and closure of distal end in 4 cases,debridement of necrosed hepatic tissue and cholecystotomy in 1 case,and vacuum sealing drainage in 2 cases.Bacteriological culture and examinations of abdominal fluid were performed and antibiotics was given in all the 35 cases.Seventeen cases were associated with septic shock and 1 case(2.7%)died of MODS due to severe intra-abdominal infection.The remaining cases were cured.Conclusion Miss-diagnosis of intestinal injury ,inappropriate primary surgical treatment and delayed rup-ture following gastrointestinal contusion are main causes of severe intra-abdominal infection in abdominal injuries . Operative control of infectious source and early rational use of antibiotics are the key elements to treat severe intra -abdominal infection .

Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.

Objective To investigate clinical effect of damage control surgery (DCS) in treatment of patients with flail chest combined with severe multiple injuries.Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments:DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs ; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib.Complications,mortality,and main parameters before and after operation in each group were analyzed and compared.Results Complications including pulmonary infection (32 cases),atelectasis (38 cases),and acute lung injury (ALI)/ARDS (39 cases) were found.Twenty-two cases died,including 13 deaths from ARDS,two from tension pneumothorax,one from massive hemoptysis,three from cardiac shock,two from craniocerebral injury,and one from liver trauma and thus the overall death rate occupied 11.8％.Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P ＜ 0.01),but the change of OI was inappreciable in Group B.Mortality,complication rate,cases treated with mechanical ventilation,tracheotomy or fiberoptic bronchoscopy,and average length of ICU and hospital stay were the lowest in the DCS Group,followed by a relatively higher result in Group B and a much higher result in Group A (P ＜ 0.01).Conclusion DCS decreases mortality and complications dramatically when appolied to treat flail chest combined with severe multiple trauma.

Objective To investigate the early stage diagnosis and treatment of patients with combined thoracoabdominal injury.Methods A retrospective review of 116 patients with combined thoracoabdominal injury admitted to our hospital from Jan,2002 to Jan,2012 was conducted.The data includes etiology,injury condition,injury severity scale(ISS),diagnosis and treatment procedure and operative route,etc.Results In 116 cases,5 cases were diagnosed by chest X-ray or CT,3 cases by exploration of the wound tract,2 cases by intestinal toke off from thoracic cavity,7 cases by emergent operation and 99 other cases(85.3%) by operation after being suspected because of "off side signs".2 patients died in the 90 penetrating injury,4 patients died in the 26 blunt,5 patients died because of operative or postoperative hemorrhagic shock,and 1 patient died of upper digestive tact bleeding 3 days after the operation,which was cased by the miss of determining gastric wall blood supply in the operation.Postoperative complications included bile leakage in 3 cases of serious liver injury and subphrenic infection in 3 cases,which were all cured by subphrenic drainage.The other patients were all healed via proper treatment.Conclusion Off-side signs combined mechanism of trauma,special examination and thoracic and abdominal paracentesis can increase early diagnosis rate,while the increase of the survival rate depends on early diagnosis,correct operative route,operative method and damage control surgery.