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Siletz A, Inaba K. Diagnostic approach to penetrating neck trauma: What you need to know. J Trauma Acute Care Surg 2024; 97:175-182. [PMID: 38523116 DOI: 10.1097/ta.0000000000004292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
ABSTRACT Diagnostic evaluation of penetrating neck trauma has evolved considerably over the last several decades. The contemporary approach to these injuries is based primarily on clinical signs of injury and multidetector computed tomographic angiography. The neck is evaluated as a unit, rather than relying on the surface anatomy zones in which external injuries are seen to guide the workup of internal injuries. This "no-zone" approach safely spares many patients from negative explorations and unnecessary invasive tests. The purpose of this review is to describe an evidence-based approach to the diagnostic evaluation of penetrating neck trauma, including indications for adjunctive testing beyond physical examination and multidetector computed tomographic angiography. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.
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Affiliation(s)
- Anaar Siletz
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (A.S., K.I.), Los Angeles General Medical Center; and Keck School of Medicine (A.S., K.I.), University of Southern California, Los Angeles, California
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Karmarkar R, Bodapati S, Yao L, Aroori S. A Foley catheter 'the jack of all trades': a literature review of its common and novel uses. Ann R Coll Surg Engl 2024; 106:485-491. [PMID: 37434583 PMCID: PMC11217819 DOI: 10.1308/rcsann.2023.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 07/13/2023] Open
Abstract
The Foley catheter is one of the most commonly used devices in modern surgical practice. Developed for draining the urinary bladder, this humble catheter has been employed for many other purposes ranging from urine output monitoring to complex urological investigations. Over time, it has evolved into being applied in more complex and innovative ways in various other specialties apart from urology. In this review article, we describe some of the common and novel uses of this deceptively simple device, and discuss the scope of its application in modern medicine.
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Affiliation(s)
| | - S Bodapati
- University Hospitals Plymouth NHS Trust, UK
| | - L Yao
- University Hospitals Plymouth NHS Trust, UK
| | - S Aroori
- University Hospitals Plymouth NHS Trust, UK
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Vrancken SM, Agelink N, van Waes OJ, Borger van der Burg BL, van Dongen TT, Verhofstad MH, Hoencamp R. The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: A comparative study in a live tissue porcine model with evaluation of a concise training program. J Trauma Acute Care Surg 2023; 94:599-607. [PMID: 36730102 PMCID: PMC10045958 DOI: 10.1097/ta.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prompt bleeding control in the prehospital phase is essential to improve survival from catastrophic junctional hemorrhage. This study aimed to compare the effectiveness and practicality of Foley catheter balloon tamponade (FCBT), Celox-A, and XSTAT for the treatment of catastrophic hemorrhage from penetrating groin injuries with a small skin defect in a live-tissue porcine model. In addition, this study aimed to determine whether a training program could train military personnel in application of these advanced bleeding control adjuncts. METHODS A standardized wound was created in 18 groins from 9 anesthetized swine. Eighteen military medics participated in the training program and performed a bleeding control procedure after randomization over the swine and test products and after transection of the femoral neurovascular bundle. Primary endpoints were bleeding control, time to bleeding control, rebleeding, blood loss, medic performance, and user product rating. RESULTS No significant differences were found in vital signs and laboratory values between the groups. In the Celox-A group, 3/6 groins achieved hemorrhage control. This was 6/6 in the XSTAT and FCBT groups. XSTAT scored best on application time, time to obtain hemorrhage control, hemorrhage control score, and practicality. No significant differences were found between groups for rebleeding, amount of blood loss, and medic performance. Military medics had a significant higher preference for XSTAT over Celox-A. This was not significant for FCBT. CONCLUSION All tested products proved effective in obtaining hemorrhage control. XSTAT has the highest effectivity and shortest application time for the treatment of catastrophic bleeding from nonpackable, penetrating junctional groin injuries with a small skin defect, compared with Celox-A and FCBT. XSTAT scored best on practicality. This study shows that our training curriculum can be used to train military medics with limited prior experience in the use of advanced bleeding control techniques for penetrating junctional groin injuries with small skin defect.
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Barsoom R, Rendon JJ, Bar-Or D, Palacio CH. Case report: Tree branch penetrating injury into zone III of the neck. Int J Surg Case Rep 2022; 100:107638. [PMID: 36279731 PMCID: PMC9594116 DOI: 10.1016/j.ijscr.2022.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Penetrating trauma to the neck can result in severe morbidity and mortality. Location of the injury dictates the appropriate clinical management. Challenging traumatic injuries require resourceful treatment options. CASE PRESENTATION A complex traumatic case of a foreign body penetrating the neck, the parotid gland, disrupting the internal jugular vein, with the tip resting at the anterior aspect of the C1 ring is reported. In this case, the authors seek to describe the clinical management of a vascular injury that resulted from penetrating zone III of the neck. DISCUSSION Due to the complex and dense presence of various structures in the neck, injuries can be difficult to manage. Thus, an algorithm identifies management strategies that are based on the location of the injury, signs of vascular injury, identified injured structures and the hemodynamic stability of the patient. Balloon tamponade has been described in other organs of the body and might be a therapeutic option in patients were venous injuries are difficult to access. CONCLUSION Penetrating neck injuries continue to result in significant morbidity and mortality. However, with appropriate and efficient evaluation and management, better outcomes are expected as demonstrated in this case.
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Affiliation(s)
- Randa Barsoom
- General Surgery Department, Valley Health System, Graduate Medical Education, Las Vegas, NV, United States of America
| | - J. Jesus Rendon
- South Texas Health System – McAllen, 301 West Expressway 83, McAllen, TX 78503, Trauma Department, United States of America
| | - David Bar-Or
- South Texas Health System – McAllen, 301 West Expressway 83, McAllen, TX 78503, Research Department, United States of America
| | - Carlos H. Palacio
- South Texas Health System – McAllen, 301 West Expressway 83, McAllen, TX 78503, Trauma Department, United States of America,Corresponding author.
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Kong V, Ko J, Cheung C, Lee B, Leow P, Thirayan V, Bruce J, Laing G, Khashram M, Clarke D. Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage. World J Surg 2022; 46:1067-1075. [PMID: 35211783 DOI: 10.1007/s00268-022-06474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The foley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of patients presenting with a penetrating neck injury (PNI). METHODS A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included. RESULTS A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1 day. The overall mortality rate was 11% (5/44). CONCLUSION FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.
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Affiliation(s)
- Victor Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa. .,Trauma Service, Department of Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand.
| | - Jonathan Ko
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cynthia Cheung
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Bogo Lee
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Priscilla Leow
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Varun Thirayan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - John Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Grant Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damian Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu Natal, Durban, South Africa
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Shilston J, Evans D, Simons A, Evans D. Initial management of blunt and penetrating neck trauma. BJA Educ 2021; 21:329-335. [PMID: 34447579 PMCID: PMC8377225 DOI: 10.1016/j.bjae.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- J. Shilston
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D.L. Evans
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A. Simons
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D.A. Evans
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Wheeler RT, Kovacic JP. The use of a Foley balloon catheter to control junctional hemorrhage in a dog with severe vascular injury secondary to penetrating trauma. J Vet Emerg Crit Care (San Antonio) 2021; 32:119-124. [PMID: 34450684 DOI: 10.1111/vec.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Penetrating trauma is commonly seen in dogs. The severity depends on the site of injury and tissue involved. Junctional hemorrhage can be especially challenging to control given the inaccessibility of the damaged vasculature. Methods described to control life-threatening hemorrhage in dogs include direct pressure, hemostatic gauze, hemostatic powder or granules, wound packing, tourniquets, and direct clamping of the vasculature. Foley balloon catheters (FBC) are commonly used to tamponade deep vascular hemorrhage in people, but the technique has not been previously described in the veterinary literature. OBJECTIVE To present a case of penetrating trauma (bite wound) in a dog with a transected left femoral artery and vein in which the life-threatening hemorrhage was initially controlled with tamponade using an FBC. CASE A 7-year-old neutered male Terrier mix presented in hemorrhagic shock with an Animal Trauma Triage (ATT) of 7 and modifed Glasgow coma scale (MGCS) of 17 forty-five minutes after being attacked by another dog. The dog had sustained a deep penetrating wound to the left groin. Direct pressure and gauze packing at the site of injury were not successful at slowing the hemorrhage. A 10-Fr, 55-cm Foley catheter with a 5-mL balloon was inserted into the wound tract, and the balloon was inflated with 7.5 mL of sterile saline. Hemorrhage was controlled after inflation of the Foley balloon. CBC, blood biochemistries, abdominal point-of-care ultrasound, radiographs, prothrombin time, partial thromboplastin time, and whole blood viscoelastic testing were performed. Stabilization included fluid resuscitation, analgesics, antimicrobials, and epsilon aminocaproic acid. The dog was then anesthetized to definitively identify and control the hemorrhage. Transection of the left femoral artery and vein where identified and ligated. The dog fully recovered and was discharged 32 hours later. NEW AND UNIQUE INFORMATION FBCs may be useful as an alternative technique for temporary control of life-threatening hemorrhage secondary to penetrating injuries in both the emergency department and prehospital settings.
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Affiliation(s)
- Ryan T Wheeler
- Emergency and Critical Care Department, MedVet Silicon Valley, San Jose, California, USA
| | - Jan P Kovacic
- Emergency and Critical Care Department, Horizon Veterinary Service, Lafayette, California, USA
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Himmler A, Maria Calzetta IL, Potes A, Puyana JC, Barillaro GF. The Use of a Urinary Balloon Catheter to Control Hemorrhage From Penetrating Torso Trauma: A Single-Center Experience at a Major Inner-City Hospital Trauma Center. Am Surg 2020; 87:543-548. [PMID: 33111566 DOI: 10.1177/0003134820949997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Use of a urinary catheter balloon tamponade (UCBT) in controlling traumatic hemorrhage is a frequently employed but infrequently described technique. We aim to discuss the experience of balloon tamponade as a bridge to definitive hemorrhage control in the operating room. METHODS This is retrospective review at a single institution from January 2008 to December 2018. We identified patients with active bleeding from penetrating torso trauma in whom UCBT was used to tamponade bleeding. We used revised trauma score (RTS), injury severity score (ISS), and new trauma and injury severity score (TRISS) to quantify injury severity. All surviving patients required definitively hemorrhage control in the operating room. Primary endpoint was mortality at 24 hours and 30 days. RESULTS Twenty-nine patients were managed with UCBT. Nine had hemorrhage controlled in the trauma bay, including 4 with neck trauma and 5 with cardiac trauma. Twenty patients had hemorrhage controlled in the operating room, including 15 with cardiac trauma and 5 with intra-abdominal hemorrhage. Mean RTS, ISS, and TRISS in this population were: 5.93, 19.31, and 83.78, respectively. Of the 9 patients treated in the trauma bay, 1 (11.1%) died in the first 24 hours and 2 died in the first 30 days (22.2%). Of the 20 patients treated in the operating room, 0 (0%) patients died in the first 24 hours and 3 died in the first 30 days (15.0%). CONCLUSION UCBT is an effective tool that can be used to stabilize and bridge an actively bleeding patient to definitive hemorrhage control in the operating room.
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Affiliation(s)
- Amber Himmler
- Department of Surgery, Medstar Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Andrea Potes
- Department of Surgery, Hospital Interzonal General de Agudos, Mar de Plata, Argentina
| | - Juan Carlos Puyana
- 6595 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Christian AB, Maithel S, Grigorian A, Kabutey NK, Dolich M, Kong A, Gambhir S, Sheehan BM, Nahmias J. Comparison of Nonoperative and Operative Management of Traumatic Penetrating Internal Jugular Vein Injury. Ann Vasc Surg 2020; 72:440-444. [PMID: 32949747 DOI: 10.1016/j.avsg.2020.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Small case series have suggested that selective nonoperative management (NOM) of penetrating internal jugular vein (IJV) injuries is safe and feasible in select patients lacking "hard signs" mandating exploration. Therefore, we sought to compare NOM to operative management (OM) of penetrating IJV injury, hypothesizing that both strategies have similar patient outcomes and mortality when patients are appropriately selected. METHODS The Trauma Quality Improvement Program (2013-2016) was queried for patients with penetrating IJV injury with an abbreviated injury scale score of the neck ≥3. Demographics and patient outcomes were compared between patients undergoing NOM and patients undergoing OM, followed by a multivariable logistic regression model to analyze the risk of mortality. RESULTS A penetrating IJV injury was identified in 188 (0.01%) patients meeting inclusion criteria, and OM was performed in 124 (66.0%) patients, whereas 64 (34.0%) patients underwent NOM. Although the OM group had a higher rate of pneumothorax (8.9% vs. 0.0%, P = 0.01), there was no difference in any other concomitant injuries or demographic data (all P > 0.05). The OM group had a higher rate of ventilator days (3 vs. 2 days, P = 0.01) but no other significant differences in morbidity or mortality (P > 0.05). After controlling for covariates, OM was associated with similar risk of mortality compared with NOM of patients with penetrating IJV injury (odds ratio 1.05, confidence interval 0.23-4.83, P = 0.95). CONCLUSIONS The NOM of penetrating IJV injuries is associated with similar risk of morbidity and mortality compared with OM, suggesting that NOM may be used in appropriately selected patients. Future research is needed to determine the ideal patients suited for NOM and to identify risk factors and outcomes associated with failure of NOM.
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Affiliation(s)
- Ashton B Christian
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Shelley Maithel
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Areg Grigorian
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Nii-Kabu Kabutey
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Matthew Dolich
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Allen Kong
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Sahil Gambhir
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Brian M Sheehan
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Jeffry Nahmias
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA.
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Madsen AS, Bruce JL, Oosthuizen GV, Bekker W, Smith M, Manchev V, Laing GL, Clarke DL. Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach. BJS Open 2020; 4:704-713. [PMID: 32525254 PMCID: PMC7397367 DOI: 10.1002/bjs5.50282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Many current protocols for managing penetrating neck injuries (PNIs) still suggest zonal approaches. This study was undertaken to determine the correlation between the zone of the external wound and the level of the internal injury, and to verify whether a ‘no‐zone’ approach to PNI is valid. Methods Patients admitted with a PNI to a tertiary trauma care centre between January 2011 and May 2018 were identified from a trauma database. Those with confirmed injury to the vascular system or an aerodigestive tract injury (ADTI) were included in the study. The medical records of each patient were reviewed with regard to the zone of the external wound and the level of internal injury, and the findings were compared. Results In the period under review, 1075 patients were treated for a PNI. Of these, 298 (27·7 per cent) had a confirmed vascular injury or ADTI and were included in the cohort. In 176 patients (59·1 per cent) the site of the internal injury was in the same zone as the external wound. In a further 70 patients (23·5 per cent) there was no correlation between the site of the internal injury and the external wound, and in the remaining 52 patients (17·4 per cent) the correlation could not be determined. In this cohort, all clinically assessable patients with significant injuries had either physical signs suggestive of injury or deep surgical emphysema on radiological examination. Conclusion An approach to PNI based on zones is questionable, and this study supports a no‐zone approach based on imaging guided by clinical examination.
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Affiliation(s)
- A S Madsen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - J L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - G V Oosthuizen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - W Bekker
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - M Smith
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - V Manchev
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa.,Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
BACKGROUND Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is effective. This study aims to audit the technique and outcomes of FCBT. METHODS Adult patients with PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were prospectively captured on an approved electronic registry. Retrospective analysis included demographics, major injuries, investigations, management and outcomes. RESULTS During the study period, 628 patients with PNI were treated at GSH. In 95 patients (15.2%), FCBT was utilised. The majority were men (98%) with an average age of 27.9 years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH. Computerised tomographic angiography (CTA) was done in 92.6% of patients, while eight patients (8.4%) required catheter-directed angiography. Six were performed for interventional endovascular management. Thirty-four arterial injuries were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate for haemorrhage control. Thirteen (13.7%) patients required neck exploration. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48-72 h. Two of these bled on catheter removal. A total of 36 complications were documented in 28 patients (29.5%). There was one death due to uncontrolled haemorrhage from the neck wound. CONCLUSION This large series highlights the ease of use of FCBT with high rates of success at haemorrhage control (97%). Venous injuries and minor arterial injuries are definitively managed with this technique.
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Feliciano DV. Shotgun wound to manubrium sterni, right anterior neck, and right supraclavicular area. Trauma Surg Acute Care Open 2020; 5:e000454. [PMID: 32201739 PMCID: PMC7066629 DOI: 10.1136/tsaco-2020-000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- David V Feliciano
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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Jose A, Arya S, Nagori SA, Thukral H. Management of Life-Threatening Hemorrhage from Maxillofacial Firearm Injuries Using Foley Catheter Balloon Tamponade. Craniomaxillofac Trauma Reconstr 2019; 12:301-304. [PMID: 31719955 DOI: 10.1055/s-0039-1685461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/07/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study is to evaluate the efficacy of Foley catheter in the management of hemorrhage from penetrating maxillofacial injuries in austere environment. This retrospective cohort study evaluated all penetrating head and neck trauma caused by firearm injuries reported to a military hospital at a forward aid location during 2015-2017. Foley catheter was used in the emergency management of bleeding in 11 cases. The effectiveness of this technique in controlling hemorrhage, its indication, contraindications, and complications has been explained. Out of 26 penetrating injuries received during the time period, 11 patients underwent Foley catheter balloon tamponade for the control of hemorrhage. Ten out of 11 patients responded adequately to balloon tamponade. One patient with a bullet lodged inside the neck underwent immediate surgical exploration for its removal and repair of internal jugular vein. No neurological deficits or complications were noted in any of the patients. Foley catheter balloon tamponade is very effective in managing hemorrhage from head and neck penetrating injuries. It significantly reduces the mortality by controlling bleeding from the major vessels especially in a combat environment.
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Affiliation(s)
- Anson Jose
- Department of Oral and Maxillofacial Surgery, 15 Corps Dental Unit, Srinagar, Jammu and Kashmir, India
| | - Saurabh Arya
- Department of Oral and Maxillofacial Surgery, 92 Base Hospital, Srinagar, Jammu and Kashmir, India
| | - Shakil Ahmed Nagori
- Department of Oral and Maxillofacial Surgery, 303 Field Hospital, 56 APO, India
| | - Himanshu Thukral
- Department of Oral and Maxillofacial Surgery, Research and Referral, New Delhi, India
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Abstract
Penetrating neck injuries are becoming more common because of the increasing prevalence of knife and gun crimes. The immediate and long-term consequences of injury to the neck can be significant because of the close relationship of important anatomical structures in a confined space. Delayed recognition of major injury and inadequate treatment results in high morbidity and mortality. Developing a clear understanding of the underlying anatomy, common mechanisms of injury and principles of management will provide first responders, emergency doctors and trauma surgeons with confidence in appropriate evidence-based management. Early involvement of otolaryngologists or head and neck surgeons is advisable. Two cases of penetrating neck injury from the June 2017 London Bridge terror attack are discussed.
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Affiliation(s)
- A M Khan
- Core Surgical Trainee, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT
| | - J C Fleming
- Specialist Registrar in Head and Neck Surgery, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London
| | - J P Jeannon
- Consultant Head and Neck Surgeon, Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London
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15
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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Neck Injuries: a Complex Problem in the Deployed Environment. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Abstract
Penetrating neck injuries are serious as there is a high concentration of vital structures in close proximity to each other in a compressed anatomical area. Penetrating neck injuries can be immediately life threatening due to massive bleeding from vascular structures or due to airway compromise. Injury to the digestive tract in the neck may also result in delayed and potentially life-threatening conditions. The majority (79%) of penetrating neck injuries can be managed conservatively. The clinician caring for such a patient requires a structured and comprehensive approach to managing these injuries. This article will provide a general overview of penetrating neck injuries, including resuscitation, epidemiology, surgical management and the use of appropriate imaging.
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Affiliation(s)
- R Weale
- Department of General Surgery, Wessex Deanery, Wessex, UK
| | - A Madsen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - VY Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - DL Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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18
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Madsen AS, Bruce JL, Oosthuizen GV, Bekker W, Laing GL, Clarke DL. The Selective Non-operative Management of Penetrating Cervical Venous Trauma is Safe and Effective. World J Surg 2018; 42:3202-3209. [DOI: 10.1007/s00268-018-4595-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Madsen AS, Kong VY, Oosthuizen GV, Bruce JL, Laing GL, Clarke DL. Computed Tomography Angiography is the Definitive Vascular Imaging Modality for Penetrating Neck Injury: A South African Experience. Scand J Surg 2017; 107:23-30. [DOI: 10.1177/1457496917731187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Computed tomography angiography has become central to the diagnostic algorithm for penetrating neck injury, but despite its widespread use the literature to support this adoption is limited. We reviewed our experience with computed tomography angiography for the identification of vascular trauma in hemodynamically stable patients with penetrating neck injury at a major trauma center in South Africa. Materials and Methods: A prospectively kept trauma registry capturing data in real time was retrospectively reviewed. All patients with penetrating neck injury investigated with computed tomography angiography as the initial vascular investigation during a 47-month period were included. Results: A total of 380 patients were included. Indications for computed tomography angiography were as follows: hard signs (13), soft signs (201), no signs but proximity/zone I or III wounds (141), and undefined signs of vascular injury (25). Of the 380 scans, 7 (1.8%) were indeterminate, 299 (78.7%) negative, and 74 (19.5%) positive for a vascular injury (54 arterial and 20 isolated venous injury). Eight were false positive and 4 false negative. The sensitivity, specificity, positive, and negative predictive values for detecting arterial injury were 93.9%, 97.5%, 85.2%, and 99.1%, respectively. Overall, the yield for demonstrating “true arterial injury” was 12.1% (46/380); hard signs: 76.9% (10/13), soft signs: 16.4% (33/201), and no signs: 2.1% (3/141) which all were secondary to gunshot wounds). Only 8.4% (32/380) required intervention for arterial injury and none for isolated venous injury (hard signs: 62.0%, soft signs: 11.4%, and no signs: 0.7%). No serious complications resulted from computed tomography angiography. Conclusion: Computed tomography angiography is a safe and effective imaging modality for the investigation of vascular trauma post penetrating neck injury. Asymptomatic patients with stab wounds do not need to be imaged regardless of proximity concerns. Symptomatic stable patients including a subgroup with hard signs should be imaged rather than explored. Computed tomography angiography provides an interventional road map and can identify injuries amenable to endovascular or conservative management.
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Affiliation(s)
- A. S. Madsen
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - V. Y. Kong
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - G. V. Oosthuizen
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - J. L. Bruce
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - G. L. Laing
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - D. L. Clarke
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
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Abstract
PURPOSE OF REVIEW Damage control surgery (DCS) has become a lifesaving maneuver for critically injured patients when utilized in appropriate scenarios. Despite this reality, indications for initiating DCS remain debated. RECENT FINDINGS Despite discussion surrounding the appropriate indications for DCS, this series of fundamental principles includes a rapidly abbreviated operative intervention aimed at arresting ongoing hemorrhage and containing gastrointestinal contamination in a patient approaching physiologic exhaustion, which includes both vascular and nonvascular damage control techniques, in addition to management of the open abdomen. Patients are then returned to the operating theater for definitive reconstruction once their physiology has been stabilized within the ICU. SUMMARY DCS is lifesaving when applied in appropriate clinical scenarios involving critically injured patients. Overuse of this technique can lead to increased patient morbidity and cost however.
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Navsaria PH, Chowdhury S, Nicol AJ, Edu S, Naidoo N. Penetrating Trauma to the Mediastinal Vessels: a Taxing Injury. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
It is more than 20 years since the term ‘Damage control’ was introduced to describe an emerging surgical strategy of abbreviated laparotomy for exsanguinating trauma patients. This strategy of temporisation and prioritisation of physiological recovery over completeness of anatomical repair was associated with improved survival in a subset of patients with combined major vascular and multiple visceral injuries. The ensuing years saw the rapid adoption of these principles as standard of care for massively injured and physiologically exhausted patients. Resuscitation of severely injured patients has changed significantly in the last decade with the emergence of a new resuscitation paradigm termed ‘damage control resuscitation’. Originating in combat support hospitals, damage control resuscitation emphasises the primacy of haemorrhage control while directly targeting the ‘lethal triad’ of coagulopathy, acidosis, and hypothermia. Integral to damage control resuscitation is the appropriate application of damage control surgery and together they constitute the modern damage control paradigm. This review aims to discuss the modern application of damage control resuscitation and damage control surgery and to review the evidence supporting its constituent components, as well as considering deficiencies in current knowledge and areas for future research.
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Affiliation(s)
- Patrick MacGoey
- East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK
| | - Christopher M Lamb
- East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK
| | - Alex P Navarro
- East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK
| | - Adam J Brooks
- East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK
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Abstract
Acute penetrating injuries to the head and neck cause considerable anxiety for most clinicians owing to concern for airway control and neurologic injury and to limited clinician experience in most centres. This article discusses an organized approach to the evaluation and initial treatment of penetrating injuries to the head and neck based on regional anatomy and clinical examination. The approach is particularly helpful in the context of ongoing hemorrhage and/or airway compromise.
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Affiliation(s)
- Chad G Ball
- The Department of Surgery, University of Calgary, and the Foothills Medical Centre, Calgary, Alta
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Skrypnik DA, Vinogradov RA, Magamet VP, Kovalenko AL. Transcarotid balloon occlusion of the brachiocephalic artery to control bleeding due to sharp injuries of the right subclavian artery. Trauma Case Rep 2015; 1:21-24. [PMID: 30101171 PMCID: PMC6082442 DOI: 10.1016/j.tcr.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
We present a new manoeuvre of transcarotid balloon occlusion of the brachiocephalic artery to control bleeding due to sharp injuries of the right subclavian artery. To control the bleeding, we employed a temporary balloon occlusion of the brachiocephalic artery with a 6.0 Fogarty balloon catheter, which was introduced through ECA retrogradely into the aorta, inflated and pulled back. Described manoeuvre is simple, rapid performed, relatively safe and it is capable of decreasing the morbidity and mortality rates of patients with sharp injuries to the right subclavian artery.
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Affiliation(s)
- Denis A Skrypnik
- Department of Vascular Surgery, State Budget Institution of Public Health Department, Research Institute Regional Clinical Hospital №1 after prof. S.V. Ochapovsky, Krasnodar, Russian Federation.,St. 1 May 167, 350086 Krasnodar, Russian Federation
| | - Roman A Vinogradov
- Department of Vascular Surgery, State Budget Institution of Public Health Department, Research Institute Regional Clinical Hospital №1 after prof. S.V. Ochapovsky, Krasnodar, Russian Federation.,St. 1 May 167, 350086 Krasnodar, Russian Federation
| | - Victoria P Magamet
- Department of Vascular Surgery, State Budget Institution of Public Health Department, Research Institute Regional Clinical Hospital №1 after prof. S.V. Ochapovsky, Krasnodar, Russian Federation.,St. 1 May 167, 350086 Krasnodar, Russian Federation
| | - Alexey L Kovalenko
- Department of Vascular Surgery, State Budget Institution of Public Health Department, Research Institute Regional Clinical Hospital №1 after prof. S.V. Ochapovsky, Krasnodar, Russian Federation.,St. 1 May 167, 350086 Krasnodar, Russian Federation
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25
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Kirkpatrick AW, Vis C, Dubé M, Biesbroek S, Ball CG, Laberge J, Shultz J, Rea K, Sadler D, Holcomb JB, Kortbeek J. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations). Injury 2014; 45:1413-21. [PMID: 24560091 DOI: 10.1016/j.injury.2014.01.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/25/2013] [Accepted: 01/18/2014] [Indexed: 02/02/2023]
Abstract
Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting existing ones, to address the need for single-site flexible haemorrhage control. This manuscript therefore describes the many considerations in the design and refinement of the physical build, equipment selection, human factors evaluation of new combined treatment paradigms, and the final introduction of a RAPTOR protocol in order that others may learn from our initial efforts.
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Affiliation(s)
- Andrew W Kirkpatrick
- Department of Surgery, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada.
| | | | | | | | - Chad G Ball
- Department of Surgery, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada
| | | | | | - Ken Rea
- Dialog Corporation, Calgary, Alberta, Canada
| | - David Sadler
- Department of Radiology, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada
| | - John B Holcomb
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Kortbeek
- Department of Surgery, Calgary, Alberta, Canada; Department of Critical Care Medicine, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada
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26
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Abstract
Damage control resuscitation (DCR) represents the natural evolution of the initial concept of damage control surgery. It currently includes early blood product transfusion, immediate arrest and/or temporization of ongoing hemorrhage (i.e., temporary intravascular shunts and/or balloon tamponade) as well as restoration of blood volume and physiologic/hematologic stability. As a result, DCR addresses the early coagulopathy of trauma, avoids massive crystalloid resuscitation and leaves the peritoneal cavity open when a patient approaches physiologic exhaustion without improvement. This concept also applies to severe injuries within anatomical transition zones as well as extremities. This review will discuss each of these concepts in detail.
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Affiliation(s)
- Chad G Ball
- From the University of Calgary and Foothills Medical Centre, Calgary, Alta
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27
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Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg 2014; 75:936-40. [PMID: 24256663 DOI: 10.1097/ta.0b013e31829e20e3] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Improved mortality from penetrating neck and maxillofacial trauma using Foley catheter balloon tamponade in combat. J Trauma Acute Care Surg 2013; 75:220-4. [DOI: 10.1097/ta.0b013e3182930fd8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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30
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Aydin C, Ersan V, Baskiran A, Unal B, Kayaalp C, Yilmaz S. Controlling massive hemorrhage from the retropancreatic portal vein as a complication of thromboendovenectomy during liver transplantation with balloon catheter tamponade: how to do it. Surg Today 2013; 44:792-4. [PMID: 23812900 DOI: 10.1007/s00595-013-0647-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/21/2013] [Indexed: 11/24/2022]
Abstract
We herein describe two cases of liver transplantation with portal vein thrombosis. In both cases, a tear advancing to the retropancreatic area occurred during portal vein thrombectomy. Hemorrhage from the limited visibility retropancreatic area made it impossible to stop the bleeding by clamping or direct suturing, and the clamping and suturing efforts actually increased the hemorrhage, possibly due to the damaged and thin portal vein wall. First, finger compression over the retropancreatic area was employed to stop the bleeding, then a Foley urinary catheter was introduced into the portal vein under the finger. The balloon of the catheter was inflated with 8 cc of normal saline, and the finger was released. The bleeding was stopped temporarily, and two different venous conduits were sutured to the trimmed portal vein stump in a bloodless surgical area. The venous conduits were easily controlled with vascular clamps after deflating the balloon catheters, and implantation of the liver was then done in a standard manner. Balloon tamponade can be a lifesaving technique that can temporarily stop a hemorrhage to allow for definitive repair in cases of retropancreatic portal vein hemorrhage.
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Affiliation(s)
- Cemalettin Aydin
- Department of Surgery and Liver Transplantation Unit, Inonu University, 44315, Malatya, Turkey
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31
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Van Waes OJ, Cheriex KCAL, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg 2012; 99 Suppl 1:149-54. [PMID: 22441870 DOI: 10.1002/bjs.7733] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. METHODS Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. RESULTS Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. CONCLUSION FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.
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Affiliation(s)
- O J Van Waes
- Departments of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Burgess CA, Dale OT, Almeyda R, Corbridge RJ. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol 2012; 37:44-52. [PMID: 22152036 DOI: 10.1111/j.1749-4486.2011.02422.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although relatively uncommon, penetrating neck trauma has the potential for serious morbidity and an estimated mortality of up to 6%. The assessment and management of patients who have sustained a penetrating neck injury has historically been an issue surrounded by significant controversy. OBJECTIVES OF REVIEW: To assess recent evidence relating to the assessment and management of penetrating neck trauma, highlighting areas of controversy with an overall aim of formulating clinical guidelines according to a care pathway format. TYPE OF REVIEW Structured, non-systematic review of recent medical literature. SEARCH STRATEGY An electronic literature search was performed in May 2011. The Medline database was searched using the Medical Subject Headings terms 'neck injuries' and 'wounds, penetrating' in conjunction with the terms 'assessment' or 'management'. Embase was searched with the terms 'penetrating trauma' and 'neck injury', also in conjunction with the terms 'assessment' and 'management'. Results were limited to articles published in English from 1990 to the present day. EVALUATION METHOD Abstracts were reviewed by the first three authors to select full-text articles for further critical appraisal. The references and citation links of these articles were hand-searched to identify further articles of relevance. RESULTS 147 relevant articles were identified by the electronic literature search, comprising case series, case reports and reviews. 33 were initially selected for further evaluation. CONCLUSIONS Although controversy continues to surround the management of penetrating neck trauma, the role of selective non-operative management and the utility of CT angiography to investigate potential vascular injuries appears to be increasingly accepted.
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Affiliation(s)
- C A Burgess
- Department of ENT Surgery, The Royal Berkshire Hospital, Reading, UK.
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33
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Balloon Foley catheter compression as a treatment for intercostal vessel bleeding. Injury 2011; 42:958-9. [PMID: 21664614 DOI: 10.1016/j.injury.2011.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/02/2011] [Accepted: 05/09/2011] [Indexed: 02/02/2023]
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Sobnach S, Nicol A, Nathire H, Kahn D, Navsaria P. Management of the retained knife blade. World J Surg 2011; 34:1648-52. [PMID: 20195600 DOI: 10.1007/s00268-010-0514-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The retained knife blade is an unusual and spectacular injury. The aim of this study was to review our experience with the management of such injuries. METHODS A retrospective chart review of patients with retained knife blades treated at Groote Schuur Hospital Trauma Centre from January 1996 to December 2007 was undertaken. RESULTS Thirty-three patients with retained knife blades were identified. Site of wound entry was the thorax in 13 patients (40%), the neck and back in 7 patients (21%) each, upper and lower extremities in 4 (12%), and the face and abdomen in 1 patient (3%) each. Thirty patients (91%) were hemodynamically stable on admission; two (6%) presented with wound abscesses, and one patient (3%) with active bleeding required emergency surgery. All 33 blades were extracted after clinical and radiological assessment. Simple withdrawal of the blade was possible in 19 cases (58%) and the likelihood of post-extraction bleeding was only 5%. Thirteen patients (40%) required an open surgical approach through dissection of the entry wound, laparotomy, or thoracotomy. Video-assisted thoracoscopic removal was used in one case. Retained thoracic blades were significantly associated with postoperative sepsis (P = 0.0054). There were no deaths. CONCLUSIONS All impacted knife injuries require careful clinical and radiological assessment. Simple withdrawal can be performed safely in the emergency room provided potential life-threatening vascular and solid organ injuries have been excluded. There should be a low threshold for investigating and treating patients with retained intrathoracic blades for postoperative sepsis.
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Affiliation(s)
- Sanju Sobnach
- Trauma Center, Groote Schuur Hospital, University of Cape Town, Observatory, 7925, Cape Town, South Africa
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35
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A Decade's Experience With Balloon Catheter Tamponade for the Emergency Control of Hemorrhage. ACTA ACUST UNITED AC 2011; 70:330-3. [DOI: 10.1097/ta.0b013e318203285c] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Hamani Y, Ben-Shachar I, Kalish Y, Porat S. Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura–induced severe uterine bleeding. Fertil Steril 2010; 94:2769.e13-5. [DOI: 10.1016/j.fertnstert.2010.04.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/25/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
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37
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Casey SJ, De Alwis WD. Review article: Emergency department assessment and management of stab wounds to the neck. Emerg Med Australas 2010; 22:201-10. [DOI: 10.1111/j.1742-6723.2010.01285.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Su WH, Cheng MH, Tsou TS, Cheung SM, Chang SP, Wang PH. Port wound closure assisted by Foley catheter: An easier way to provide fascia security. J Obstet Gynaecol Res 2009; 35:725-31. [DOI: 10.1111/j.1447-0756.2008.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Thoma M, Navsaria PH, Edu S, Nicol AJ. Analysis of 203 Patients with Penetrating Neck Injuries. World J Surg 2008; 32:2716-23. [DOI: 10.1007/s00268-008-9766-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Saraiya H. Use of Foley catheter as a flap retainer. Indian J Plast Surg 2008; 41:79-81. [PMID: 19753209 PMCID: PMC2739548 DOI: 10.4103/0970-0358.41119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Keeping skin graft or a flap adherent to the underlying surface can sometimes be a difficult job, particularly inside a cavity. Different methods have been used for this function with varying success but the search is still on for an ideal pressure dressing.
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Affiliation(s)
- Hemant Saraiya
- Sushrut Plastic Surgery Research Center and Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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