1
|
Mejia D, Warr SP, Delgado-López CA, Salcedo A, Rodríguez-Holguín F, Serna JJ, Caicedo Y, Pino LF, González-Hadad A, Herrera MA, Parra MW, García A, Ordoñez CA. Reinterventions after damage control surgery. Colomb Med (Cali) 2021; 52:e4154805. [PMID: 34908623 PMCID: PMC8634277 DOI: 10.25100/cm.v52i2.4805] [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: 03/31/2021] [Revised: 06/11/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022] Open
Abstract
Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.
Collapse
Affiliation(s)
- David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Salin Pereira Warr
- Hospital Pablo Tobón Uribe, Grupo de Soporte Nutricional y Pared Abdominal, Medellin. Colombia
| | | | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| |
Collapse
|
2
|
American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries. J Trauma Acute Care Surg 2021; 89:1197-1211. [PMID: 33230049 DOI: 10.1097/ta.0000000000002968] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
Collapse
|
3
|
A standardized trauma-specific endovascular inventory. J Trauma Acute Care Surg 2021; 89:S83-S87. [PMID: 32176174 DOI: 10.1097/ta.0000000000002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We believe that the rapid and widespread adoption of resuscitative endovascular balloon occlusion of the aorta as well as enthusiasm for catheter-based strategies has led to increased interest in basic endovascular techniques among trauma surgeons. The aim of this article was to describe the most commonly performed endovascular procedures for trauma patients, the basic capital equipment and room set up, and a parsimonious inventory of disposable supplies needed to perform each procedure. Together, these make a standardized trauma-specific endovascular inventory. LEVEL OF EVIDENCE: Economic/decision, level V.
Collapse
|
4
|
Butler WJ, Smith JE, Tadlock MD, Martin MJ. Initial Assessment and Resuscitation of the Battlefield Casualty—an Overview. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00200-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
5
|
CT angiography of lower extremities from anatomy to traumatic and nontraumatic lesions: a pictorial review. Emerg Radiol 2020; 27:441-450. [PMID: 32221718 DOI: 10.1007/s10140-020-01770-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 12/14/2022]
Abstract
After the introduction and the quick improvement of multidetector computed tomography technology, computed tomographic angiography (CTA) has become the imaging examination of choice for the first assessment of patients affected by lower extremities acute disorders. The widespread availability of CT equipment, the high temporal and spatial resolution with post-processing reformation possibilities represent the main advantages of this technique, which can reliably identify different findings related to arterial vessel pathology, such as occlusion, dissection, active bleeding, and pseudoaneurysm. Radiologists should know the anatomy, the acquisition protocols, and the CTA appearances of the different vascular lesions. The right interpretation of CTA findings is essential to establish the best treatment management of each patient.
Collapse
|
6
|
Abstract
BACKGROUND Due to the increasing threat of terrorist attacks and assassinations even in Europe, the interest in management of severe vascular injuries, which, with an increased incidence of 10% are to be expected with such penetrating wounds, is also growing; however, with increasing subspecialization in surgery there is a threat that the know-how in vascular surgery will become lost among non-vascular surgical specialists. Therefore, the Germany military established an educational program, the so-called DUOplus concept, to ensure that future military surgeons acquire and retain the experience and skills to fulfill the demanding role of a deployed surgeon. OBJECTIVE The DUOplus concept of the German Medical Forces is introduced with a special focus on vascular surgery training. RESULTS All trainee German military surgeons attain a second specialization alongside general surgery. This residency includes several courses in various surgical specialties as well as a 12-month rotation in a vascular surgery department. The core elements of vascular trauma training are two practical courses on life-like models. In these courses, which were developed especially for the needs of non-vascular surgeons in hands-on training, open surgical techniques and damage control measures including resuscitative endovascular balloon occlusion of the aorta (REBOA) are taught on suitable models and intensively practiced. CONCLUSION All surgeons potentially confronted with traumatic and iatrogenic vascular injuries should have some basic competence in the management of vascular trauma. Especially the courses in vascular surgery for non-vascular surgeons offer such a skill set for every surgeon. Next to the German military surgeons, the courses are attended more and more by civilian and military surgeons from different surgical specialties and nationalities.
Collapse
|
7
|
|
8
|
Osborn LA, Brenner ML, Prater SJ, Moore LJ. Resuscitative endovascular balloon occlusion of the aorta: current evidence. Open Access Emerg Med 2019; 11:29-38. [PMID: 30666171 PMCID: PMC6336022 DOI: 10.2147/oaem.s166087] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as a minimally invasive alternative to open aortic cross-clamping in the management of patients with non-compressible hemorrhage arising below the diaphragm. The purpose of this review is to provide a description of the technical aspects of REBOA use along with an overview of the current animal and clinical data regarding its use.
Collapse
Affiliation(s)
- Lesley A Osborn
- Department of Emergency Medicine, The University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA,
| | - Megan L Brenner
- Department of Surgery, The University of California - Riverside, Moreno Valley, CA, USA
| | - Samuel J Prater
- Department of Emergency Medicine, The University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA,
| | - Laura J Moore
- Department of Surgery, The University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| |
Collapse
|
9
|
Góes Junior AMDO, Simões Neto JFA, Abib SDCV, de-Andrade MC, Ferraz TC. Trauma vascular na Amazônia: atualizando o desafio. Rev Col Bras Cir 2018; 45:e1844. [DOI: 10.1590/0100-6991e-20181844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar dados epidemiológicos dos pacientes operados por trauma vascular em hospital de referência para traumatismos vasculares do Estado do Pará, determinar as variáveis que aumentam o risco de óbito e fazer uma análise comparativa com os resultados previamente publicados pela mesma instituição. Métodos: estudo retrospectivo analítico realizado através da coleta de dados de pacientes operados por lesões vasculares, entre março de 2013 e março de 2017. Foram analisados dados demográficos e epidemiológicos, como o mecanismo e topografia da lesão, distância entre o local do trauma e o hospital, tipo de tratamento e complicações. Foi feito ainda o estudo de uma matriz de correlação com regressão logística entre as variáveis e a ocorrência de óbito. Resultados: foram estudados 288 pacientes, com 430 lesões; 92,7% era do sexo masculino, 49,7% entre 25 e 49 anos de idade; 47,2% das lesões foi ocasionada por projéteis de arma de fogo; 47,2% das lesões situava-se nos membros superiores, 42,7% nos membros inferiores, 8% em região cervical, 3,1% torácicas e 0,7% abdominais; 52,8% dos pacientes teve hospitalização por sete dias ou menos. Amputação foi necessária em 6,9% e a mortalidade foi 7,93%. Conclusão: distâncias superiores a 200km foram associadas à internação prolongada e maior probabilidade de amputação de membros. Foi encontrada correlação significativa entre a ocorrência de óbito e o fato de haver lesão arterial, lesão vascular na topografia cervical e lesão vascular na topografia torácica.
Collapse
|
10
|
Leclerc B, Boyer E, Menu G, Leclerc G, Sergent P, Ducroux E, Salomon Du Mont L, Garbuio P, Rinckenbach S, Obert L. Two-team management of vascular injuries concomitant with osteo-articular injuries in 36 patients over six years. Orthop Traumatol Surg Res 2018; 104:497-502. [PMID: 29578106 DOI: 10.1016/j.otsr.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice. HYPOTHESIS The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries. MATERIAL AND METHODS A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries. RESULTS The study included 36 patients with a mean age of 40.6±22.1 years. The main sources of injury were traffic accidents (n=19, 52.8%), crush injury (n=8, 22.2%), and falls (n=5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11 (30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11 (30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0-74.8] months. DISCUSSION Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury. LEVEL OF EVIDENCE IV, retrospective observational study.
Collapse
Affiliation(s)
- B Leclerc
- Service de chirurgie vasculaire et endovasculaire, hôpital Jean Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA 3920, université de Franche-Comté, 25000 Besançon, France.
| | - E Boyer
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| | - G Menu
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| | - G Leclerc
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| | - P Sergent
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| | - E Ducroux
- Service de chirurgie vasculaire et endovasculaire, hôpital Jean Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA 3920, université de Franche-Comté, 25000 Besançon, France
| | - L Salomon Du Mont
- Service de chirurgie vasculaire et endovasculaire, hôpital Jean Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA 3920, université de Franche-Comté, 25000 Besançon, France
| | - P Garbuio
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| | - S Rinckenbach
- Service de chirurgie vasculaire et endovasculaire, hôpital Jean Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA 3920, université de Franche-Comté, 25000 Besançon, France
| | - L Obert
- Service de chirurgie orthopédique , traumatologique, de chirurgie plastique, reconstructrice et assistance main, hôpital Jean-Minjoz, centre hospitalier universitaire, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; EA Nano Médecine-FEMTO, 25000 Besançon, France
| |
Collapse
|
11
|
Kuckelman J, Derickson M, Long WB, Martin MJ. MASCAL Management from Baghdad to Boston: Top Ten Lessons Learned from Modern Military and Civilian MASCAL Events. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0128-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Abstract
There has been an evolution in the diagnosis and management of vascular trauma over the past 100 years. The primary stimulus to these changes has been the increased volume of patients with cervical, truncal, and peripheral vascular injuries during military conflicts and in civilian life. Patients with "hard" signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with "soft" signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary. Computed tomography arteriography has become the most commonly used method of imaging, whereas duplex ultrasonography is used in some centers. Nonoperative management is now common for nonocclusive injuries diagnosed on computed tomography arteriography. Proximal tourniquets are commonly used to control exsanguinating hemorrhage from injuries to extremities, whereas balloons can be used to control hemorrhage from difficult to expose areas at operation. Temporary intraluminal shunts are now used in 3% to 9% of arterial injuries. Operative techniques of repair have been refined and contribute to the excellent results noted in modern trauma centers.
Collapse
|
13
|
Feliciano DV. Pitfalls in the management of peripheral vascular injuries. Trauma Surg Acute Care Open 2017; 2:e000110. [PMID: 29766105 PMCID: PMC5877918 DOI: 10.1136/tsaco-2017-000110] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 01/17/2023] Open
Abstract
Over the past 65+ years, most civilian peripheral vascular injuries have been managed by trauma surgeons with training or experience in vascular repair or ligation. This is appropriate as the in-hospital trauma team is immediately available, and there are often other injuries present in the victim. The pitfall to avoid during evaluation of the patient in the emergency center is a missed diagnosis. In the patient without ‘hard’ signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle–brachial (ABI) or brachial–brachial index and liberal use of CT arteriography depending on an ABI <0.9 should essentially make the diagnosis if an arterial injury is present. At operation, one pitfall is to limit skin preparation and draping, thereby eliminating the option of removing the greater saphenous vein if needed as a conduit from either the groin or ankle of an uninjured lower extremity. Another pitfall is to make a full longitudinal incision directly over a large pulsatile hematoma. Rather, separate shorter longitudinal incisions should be made to obtain proximal and distal vascular control before entering the hematoma. The failure to recognize patients who should be managed initially with insertion of a temporary intraluminal shunt is a major pitfall as well. Not following time-proven and results-proven ‘fine techniques’ of operative repair is another major pitfall. Such techniques include the following: use of small angioaccess vascular clamps or silastic vessel loops; passage of proximal and distal Fogarty catheters; administration of regional or systemic heparin during complex repairs; an open anastomosis technique; and completion arteriography after a complex arterial repair in a lower extremity. Avoiding pitfalls should allow for success in peripheral vascular repair, particularly since most patients are young with non-diseased vessels.
Collapse
Affiliation(s)
- David V Feliciano
- Division of General Surgery, Indiana University Medical Center, Indianapolis, Indiana, USA
| |
Collapse
|
14
|
Abou Ali AN, Salem KM, Alarcon LH, Bauza G, Pikoulis E, Chaer RA, Avgerinos ED. Vascular Shunts in Civilian Trauma. Front Surg 2017; 4:39. [PMID: 28775985 PMCID: PMC5517780 DOI: 10.3389/fsurg.2017.00039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/05/2017] [Indexed: 11/25/2022] Open
Abstract
Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management.
Collapse
Affiliation(s)
- Adham N Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Louis H Alarcon
- Division of Trauma and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Graciela Bauza
- Division of Trauma and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Emmanuel Pikoulis
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| |
Collapse
|
15
|
Rappold JF, Bochicchio GV. Surgical adjuncts to noncompressible torso hemorrhage as tools for patient blood management. Transfusion 2017; 56 Suppl 2:S203-7. [PMID: 27100757 DOI: 10.1111/trf.13585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
Despite the tremendous advances and successes in the care of combat casualties over the past 15 years of war, noncompressible torso hemorrhage (NCTH) remains the most likely source of potentially preventable death (approx. 25%) on the battlefield. This is also likely true for civilian victims of blunt and penetrating trauma. Various devices and therapeutic interventions have been, and are being, developed in an attempt to reduce morbidity and mortality for patients with NCTH. Examples include the use of prehospital blood and blood products, tranexamic acid, specially designed tourniquets for junctional hemorrhage control, retrograde endovascular balloon occlusion of the aorta, intracavity foam, expandable hemostatic sponges, and intravascular nanoparticles to suspended animation. Although each of these modalities offer the potential to staunch uncontrolled hemorrhage until an injured patient is able to reach definitive surgical care, further research and advances must be made to further reduce trauma morbidity and mortality and to identify those technologies and modalities that are best suited to rapid movement to the front lines of combat casualty care as well as to emergency medical personnel dealing with civilian trauma victims. The surgical adjuncts for NCTH discussed may all be considered as potential tools for patient blood management programs. If effective they offer the possibility of reduce hemorrhage and blood product exposure and improved patient outcomes.
Collapse
Affiliation(s)
- Joseph F Rappold
- Department of Surgery, Division of Acute Care Surgery, Maine Medical Center/Tufts University School of Medicine, Portland, Maine
| | - Grant V Bochicchio
- Department of Surgery, Division of Acute and Critical Care Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
16
|
Kobayashi LM, Costantini TW, Hamel MG, Dierksheide JE, Coimbra R. Abdominal vascular trauma. Trauma Surg Acute Care Open 2016; 1:e000015. [PMID: 29766059 PMCID: PMC5891707 DOI: 10.1136/tsaco-2016-000015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023] Open
Abstract
Abdominal vascular trauma, primarily due to penetrating mechanisms, is uncommon. However, when it does occur, it can be quite lethal, with mortality ranging from 20% to 60%. Increased early mortality has been associated with shock, acidosis, hypothermia, coagulopathy, free intraperitoneal bleeding and advanced American Association for the Surgery of Trauma Organ Injury Scale grade. These patients often arrive at medical centers in extremis and require rapid surgical control of bleeding and aggressive resuscitation including massive transfusion protocols. The most important factor in survival is surgical control of hemorrhage and restoration of appropriate perfusion to the abdominal contents and lower extremities. These surgical approaches and the techniques of definitive vascular repair can be quite challenging, particularly to the inexperienced surgeon. This review hopes to describe the most common abdominal vascular injuries, their presentation, outcomes, and surgical techniques to control and repair such injuries.
Collapse
Affiliation(s)
- Leslie M Kobayashi
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Michelle G Hamel
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Julie E Dierksheide
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California, San Diego, California, USA
| |
Collapse
|
17
|
Inaba K, Aksoy H, Seamon MJ, Marks JA, Duchesne J, Schroll R, Fox CJ, Pieracci FM, Moore EE, Joseph B, Haider AA, Harvin JA, Lawless RA, Cannon J, Holland SR, Demetriades D. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg 2016; 80:359-64; discussion 364-5. [DOI: 10.1097/ta.0000000000000949] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
18
|
|
19
|
Sharrock AE, Gokani VJ, Harries RL, Pearce L, Smith SR, Ali O, Chu H, Dubois A, Ferguson H, Humm G, Marsden M, Nepogodiev D, Venn M, Singh S, Swain C, Kirkby-Bott J. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom. World J Emerg Surg 2015; 10:26. [PMID: 26161133 PMCID: PMC4496942 DOI: 10.1186/s13017-015-0019-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022] Open
Abstract
The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.
Collapse
Affiliation(s)
- A. E. Sharrock
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
- />Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
| | - V. J. Gokani
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - R. L. Harries
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - L. Pearce
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - S. R. Smith
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - O. Ali
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - H. Chu
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - A. Dubois
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - H. Ferguson
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - G. Humm
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - M. Marsden
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - D. Nepogodiev
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - M. Venn
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - S. Singh
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - C. Swain
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - J. Kirkby-Bott
- />Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
| |
Collapse
|
20
|
Asensio JA, Petrone P, Pérez-Alonso A, Verde JM, Martin MJ, Sánchez W, Smith S, Marini CP. Contemporary wars and their contributions to vascular injury management. Eur J Trauma Emerg Surg 2014; 41:129-42. [PMID: 26038256 DOI: 10.1007/s00068-014-0430-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 07/06/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Man's inhumanity for man still knows no boundaries, as we continue as a species as a whole to engage in war. According to Kohn's Dictionary of Wars [1], of over 3,700 years of recorded history, there have been a total of 3,010 wars. One is hard pressed to actually find a period of time in which here has not been an active conflict in the globe. The world has experienced two world wars: WWI (1914-1918) and WWII (1939-1945). The total number of military casualties in WWI was over 37 million, while WWII so far, has been the deadliest military conflict in history with over 60 million people killed accounting for slightly over 2.5% of the world's population. MATERIAL AND METHODS The purpose of this study is to review contemporary wars and their contributions to vascular injury management. It is precisely wartime contributions that have led to the more precise identification and management of these injuries resulting in countless lives and extremities saved. However, surgeons dealing with vascular injuries have faced a tough and arduous road. Their journey was initiated by surgical mavericks which undaunted, pressed on against all odds guided by William Stewart Halsted's classic statement in 1912: "One of the chief fascinations in surgery is the management of wounded vessels." CONCLUSION Contemporary wars of the XX-XXI centuries gave birth, defined and advanced the field of vascular injury management.
Collapse
Affiliation(s)
- J A Asensio
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Creighton University, Omaha, NE, USA,
| | | | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Damage control strategies in the management of acute injury. Eur J Trauma Emerg Surg 2014; 40:143-50. [PMID: 26815894 DOI: 10.1007/s00068-014-0386-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/13/2014] [Indexed: 01/24/2023]
Abstract
Traumatic injury is the leading cause of death worldwide. The rapid evaluation and correction of injuries in these patients is paramount to preventing uncontrolled decompensation and death. Damage control strategies are a compendium of techniques refined over decades of surgical care that focus on the rapid correction of deranged physiology, control of contamination and blood loss, and resuscitation of critical patients. Damage control resuscitation (DCR) focuses on the replacement of lost blood volume in a manner mimicking whole blood, control of crystalloid administration, and permissive hypotension. Damage control laparotomy controls gastrointestinal contamination and bleeding in the operative suite, allowing rapid egress to the intensive care unit for ongoing resuscitation. Pelvic packing, an adjunct to DCR, provides a means to control hemorrhage from severe pelvic fractures. Temporary vascular shunts restore perfusion, while resuscitation and reconstruction are ongoing. Taken together, these strategies provide the trauma surgeon with a powerful arsenal to preserve life in the transition from injury to the shock trauma room to the intensive care unit.
Collapse
|