Will the damage control concept influence the principles for setting priorities for severely traumatized patients in disaster situations?

Multiple small bowel ligation compared to conventional primary repair after abdominal gunshot wound with haemorrhagic shock

AIMS

The aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haemorrhagic shock compared with conventional surgery.

METHODS

Eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. The animals were bled to a mean arterial pressure of 50 mm Hg for 30 minutes, after which they were resuscitated and had laparotomy. They were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel -injuries and early rapid multiple bowel ligation group (n?=?9). Repeated measurement analysis of variance was used for analysis.

RESULTS

There was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. Lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. There were no significant differences in mean arterial pressure, cardiac output , stroke volume or systemic vascular resistance between the groups. The mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (SEM) minutes, compared with 116.4 (1.74) (SEM) minutes in the conventional surgery group, p =0.001).

CONCLUSIONS

Damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.

Severe tyre blast injuries during servicing

BACKGROUND

The destructive potential of the tyre explosions has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. These blasts mainly affect the personnel servicing big vehicle tyres such as trucks and buses. We aimed to review the relevant literature on tyre blast injuries so as to define the mechanism of injury, outcome, and its methods of prevention.

METHODS

A search of the English literature on tyre blast injuries was performed through Medline. Different studies were retrieved, analysed and combined together.

RESULTS

A total of 763 patients were studied in the literature. Most of the patients were young aged male mechanics and the explosions usually occur during tyre servicing especially during inflation. Injury is caused by the pressure impact of the explosion or by direct hit of the rim. The head and face are the most commonly affected regions (48%) followed by the upper limbs (20%). About 25% of patients had multi-trauma. The overall mortality is high (19%) and is mainly caused by head injuries.

CONCLUSION

Inflated large tyres contain a tremendous amount of potential energy. Tyre blast injuries during servicing have a high morbidity and mortality. Preventive occupational methods should be implemented.

The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery

BACKGROUND

This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis.

METHODS

Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases.

RESULTS

The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups.

CONCLUSIONS

Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.