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Cherfan P, Cobler-Lichter MD, Kronenfeld JP, Weiss Z, Byers PM. Heterotopic Ossification of the Abdomen: A Rare Sequela Following Trauma and Damage Control Laparotomy. Am Surg 2024; 90:1787-1790. [PMID: 38532253 DOI: 10.1177/00031348241241629] [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] [Indexed: 03/28/2024]
Abstract
Heterotopic ossification (HO) of the abdomen is a rare yet highly morbid complication following blunt and penetrating trauma requiring damage control laparotomy. We present the case of a 22-year-old man, 20 months after life-threatening motor vehicle crash with major vascular injury requiring multiple abdominal surgeries. The patient was initially treated at a community hospital and subsequently developed a chronic left lower quadrant enterocutaneous fistula, accompanied by a gradually worsening diffuse abdominal pain. He was referred to our tertiary care center with extensive skin breakdown and an inability to control the fistula despite numerous wound care consultations. He also had severe abdominal deformities due to HO in the abdominal wall, peritoneum, paraspinal muscles, and parapelvic regions. As HO is largely underreported, it is crucial to refer those patients, once medically stabilized, to tertiary care centers for surveillance and possible treatment when symptomatic.
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Affiliation(s)
- Patrick Cherfan
- Division of Trauma, Surgical Critical Care & Burns, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Michael D Cobler-Lichter
- Division of Trauma, Surgical Critical Care & Burns, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Joshua P Kronenfeld
- Division of Trauma, Surgical Critical Care & Burns, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Zoe Weiss
- Division of Trauma, Surgical Critical Care & Burns, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Patricia M Byers
- Division of Trauma, Surgical Critical Care & Burns, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
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Sun F, Zhang Y, Ji Q, Zhang T, Zhu Y, Zhang Z, Han R, Wen L. A New Antirotation Strategy of K-Wire Tension Band Therapy for Patellar Fracture. Front Surg 2022; 9:891869. [PMID: 35620198 PMCID: PMC9127318 DOI: 10.3389/fsurg.2022.891869] [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: 03/08/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patellar fracture is a common phenomenon observed in orthopedic clinics. Many methods have been shown to be effective in the fixation of patellar fracture. However, there are few studies on the antirotation effect of these methods. The purpose of this study is to present a new strategy of K-wire tension band therapy for patellar fracture and explore the antirotation effect of the modified tension band method on patellar fracture. Methods A retrospective clinical observation study was conducted on 75 patients with patellar fracture. Totally, 46 patients were enrolled to the traditional group, who received the traditional K-wire tension band therapy. The modified group included 29 patients on whom our new strategy was implemented. The operation time, intraoperative blood loss, and fracture healing time were collected to compare the two operations and the knee society score (KSS) scores after the operations, and complications were recorded and retrieved to indicate the effectiveness of the two treatments. Results The preoperative baseline data (gender, age, fracture types) of the two groups showed no significant statistical difference. Similarly, there was no significant difference in the operation time, intraoperative blood loss, and fracture healing time between the two groups. The KSS clinical scores 1 year after operation was 90 (84, 95) for the traditional group as compared with 99 (97, 100) for the modified group (p < 0.05). The KSS functional scores 1 year after operation in the two groups were 90 (65, 90) and 100 (90, 100) (p < 0.05). The incidences of complications due to the rotation of K-wires in the traditional group and the modified group were 76.1% (35 of 46) and 6.9% (2 of 29) with a significant statistical difference (p < 0.05). Conclusion This study shows that our modified tension band therapy is an effective strategy for antirotation in the treatment of patellar fracture and proves that it can achieve better clinical outcomes than the traditional K-wire tension band method. This new strategy may be a safe and effective clinical technique for the treatment of patellar fracture. However, more prospective randomized controlled trials with larger sample sizes are still needed to further prove its efficacy.
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Affiliation(s)
| | | | | | | | | | | | | | - Liangyuan Wen
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Jacob MO, Reddipogu J, Jacob J. Abdominal wall heterotopic ossification following damage control laparotomy: an unusual bone to pick. ANZ J Surg 2021; 91:902-906. [PMID: 33475229 DOI: 10.1111/ans.16596] [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: 11/16/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) refers to the development of extra-skeletal bone in muscle and soft tissues, following tissue insult secondary to surgery or trauma. This pathological process is considered as the result of severe inflammatory cell cascade initiated after local trauma and subsequent attempt at tissue repair involving resident mesenchymal cells. We present a series of 12 cases of abdominal HO (AHO), over 8 years, following damage control laparotomies (DCLs). METHODS Medical records of 50 patients who underwent DCLs at Alice Springs Hospital between 2010 and 2018 were retrospectively reviewed for AHO. Demographic data were extracted. Abdominal X-rays and computed tomography scans of 47 patients were reviewed for AHO. RESULTS Twelve patients (25%) developed AHO of varying diversity ranging from small insignificant lesions to clinically palpable lesions in the abdominal wall. Data revealed relatively younger male preponderance. DCL for severe acute pancreatitis (SAP) was associated with AHO (P < 0.1, 90% CI). Longer periods of ventilation, intensive care unit stay and admission to hospital were strongly associated with AHO (P < 0.01, 95% CI). Occurrence of AHO with SAP was significantly higher compared to patients without SAP (relative risk 3.54, P < 0.001). Only two patients required surgical excision of HO prior to definitive closure of the abdomen. CONCLUSION The authors conclude that AHO occurred more frequently in younger males. DCL for SAP was a significant risk factor. Extended periods of ventilation, intensive care unit stay and hospital admission were strongly associated with the development of AHO. Preoperative detection of HO is essential prior to planning definitive closure of the abdomen.
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Affiliation(s)
- Mathew O Jacob
- Department of General Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Jonathan Reddipogu
- Department of General Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Jacob Jacob
- Department of General Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Wang Y, Alnumay A, Paradis T, Beckett A, Fata P, Khwaja K, Razek T, Grushka J, Deckelbaum DL. Management of Open Abdomen After Trauma Laparotomy: A Comparative Analysis of Dynamic Fascial Traction and Negative Pressure Wound Therapy Systems. World J Surg 2020; 43:3044-3050. [PMID: 31506714 DOI: 10.1007/s00268-019-05166-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Management of the post-traumatic open abdomen (OA) using negative pressure wound therapy (NPWT) alone is associated with low rates of primary fascial closure. The abdominal reapproximation anchor (ABRA) system exerts dynamic medial fascial traction and may work synergistically with NPWT to facilitate primary fascial closure. METHODS Patients with an OA following trauma laparotomy between 2009 and 2018 were identified from a prospectively maintained institutional database. Patients treated with ABRA in conjunction with NPWT (ABRA) versus NPWT alone (NPWT) were compared in terms of primary fascial closure rate, number of surgeries to closure, tracheostomy duration, length of stay and incidence of entero-atmospheric fistula. Multivariable linear regression was performed to identify predictors of tracheostomy duration. RESULTS We identified 48 patients [ABRA, 12 and NPWT, 36]. The ABRA group was significantly younger (25 vs. 37 years, p = 0.027) and included a lower proportion of males (58% vs. 89%, p = 0.032). Groups were similar with respect to the incidence of hollow viscus injury, injury severity score and abdominal abbreviated injury score. Compared to the NPWT group, the ABRA group had a significantly higher rate of primary fascial closure (100% vs. 28%, p < 0.001), fewer surgeries to abdominal closure (2 vs. 2.5, p = 0.023) and shorter duration of tracheostomy (15.5 vs. 36 days, p = 0.008). There were no differences in length of stay or incidence of entero-atmospheric fistula. On multivariable linear regression, ABRA placement was an independent predictor of shorter tracheostomy duration, after adjusting for covariates (β = - 0.294, p = 0.036). CONCLUSION For the post-traumatic OA, ABRA coupled with NPWT achieves a higher rate of primary fascial closure compared to NPWT alone, while requiring fewer surgeries and a shorter duration of tracheostomy.
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Affiliation(s)
- Yifan Wang
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Abdulaziz Alnumay
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Tiffany Paradis
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Andrew Beckett
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Paola Fata
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Kosar Khwaja
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Tarek Razek
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada.,Centre for Global Surgery, McGill University, Montreal, QC, Canada
| | - Jeremy Grushka
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada
| | - Dan L Deckelbaum
- Division of Trauma Surgery, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9-411, Montreal, QC, H3G 1A4, Canada. .,Centre for Global Surgery, McGill University, Montreal, QC, Canada.
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Sorkin M, Huber AK, Hwang C, Carson WF, Menon R, Li J, Vasquez K, Pagani C, Patel N, Li S, Visser ND, Niknafs Y, Loder S, Scola M, Nycz D, Gallagher K, McCauley LK, Xu J, James AW, Agarwal S, Kunkel S, Mishina Y, Levi B. Regulation of heterotopic ossification by monocytes in a mouse model of aberrant wound healing. Nat Commun 2020; 11:722. [PMID: 32024825 PMCID: PMC7002453 DOI: 10.1038/s41467-019-14172-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/13/2019] [Indexed: 11/08/2022] Open
Abstract
Heterotopic ossification (HO) is an aberrant regenerative process with ectopic bone induction in response to musculoskeletal trauma, in which mesenchymal stem cells (MSC) differentiate into osteochondrogenic cells instead of myocytes or tenocytes. Despite frequent cases of hospitalized musculoskeletal trauma, the inflammatory responses and cell population dynamics that regulate subsequent wound healing and tissue regeneration are still unclear. Here we examine, using a mouse model of trauma-induced HO, the local microenvironment of the initial post-injury inflammatory response. Single cell transcriptome analyses identify distinct monocyte/macrophage populations at the injury site, with their dynamic changes over time elucidated using trajectory analyses. Mechanistically, transforming growth factor beta-1 (TGFβ1)-producing monocytes/macrophages are associated with HO and aberrant chondrogenic progenitor cell differentiation, while CD47-activating peptides that reduce systemic macrophage TGFβ levels and help ameliorate HO. Our data thus implicate CD47 activation as a therapeutic approach for modulating monocyte/macrophage phenotypes, MSC differentiation and HO formation during wound healing.
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Affiliation(s)
- Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Amanda K Huber
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Charles Hwang
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - William F Carson
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rajasree Menon
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John Li
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kaetlin Vasquez
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Chase Pagani
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Shuli Li
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Noelle D Visser
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yashar Niknafs
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Shawn Loder
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Melissa Scola
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Dylan Nycz
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Katherine Gallagher
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Laurie K McCauley
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shailesh Agarwal
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Stephen Kunkel
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuji Mishina
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Benjamin Levi
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
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Kim H. Heterotopic Ossification in the Abdominal Wall after Exploratory Laparotomy. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Hohyun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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