1
|
Hamilton JM, Chan TG, Moore CE. Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols. Otolaryngol Clin North Am 2023; 56:1013-1025. [PMID: 37353366 DOI: 10.1016/j.otc.2023.05.006] [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: 06/25/2023]
Abstract
Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment.
Collapse
Affiliation(s)
- James M Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Tyler G Chan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Charles E Moore
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA
| |
Collapse
|
2
|
Wang H, Chen H, Liu C, Yuan L, Bao Y, Zhao G, Wang D, Song G. Successful resuscitation and multidisciplinary management of penetrating brain injury caused by tire explosion: A case report. Medicine (Baltimore) 2022; 101:e32048. [PMID: 36451440 PMCID: PMC9704937 DOI: 10.1097/md.0000000000032048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Penetrating brain injury (PBI) is a rare trauma that presents as a difficult and serious surgical emergency for neurosurgeons in clinical practice. Our patient was admitted with a PBI caused by a tire explosion, which is an extremely rare cause of injury. PATIENT CONCERNS We report a case of a 28-year-old male patient who suffered a PBI when a tire exploded while it was being inflated with a high-pressure air pump. DIAGNOSES The patient was diagnosed with PBI presenting with multiple comminuted skull fractures, massive bone fragments with foreign bodies penetrating the underlying brain tissue of the top right frontal bone, multiple cerebral contusions, and intracranial hematoma. INTERVENTIONS Emergency combined multidisciplinary surgery was performed for the removal of the fragmented bone pieces, hematoma, and foreign bodies; decompression of the debridement flap; reconstruction of the anterior skull base; and repair of the dura mater. OUTCOMES The patient was successfully resuscitated and discharged 1 month later and is now recovering well. LESSONS Patients with PBI are critically ill. Therefore, timely, targeted examinations and appropriate multidisciplinary interventions through a green channel play a key role in assessing the condition, developing protocols, and preventing complications.
Collapse
Affiliation(s)
- Haozhan Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Hao Chen
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Changtong Liu
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Long Yuan
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Yonggang Bao
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guodong Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dengqin Wang
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Guohong Song
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- * Correspondence: Guohong Song, The Affiliated Hospital of Jining Medical University, No. 89 Guhuai Street, Jining 272000, Shandong Province, China (e-mail: )
| |
Collapse
|
3
|
Takahashi T, Kaneko T, Hane A, Ito A, Kawamoto E, Suzumura M, Ueda K, Shinoda M, Ito A, Imai H. Conservative medical management combined with follow-up multidetector computed tomography of tracheobronchial injury caused by penetrating injuries: A case report. Trauma Case Rep 2022; 42:100710. [PMID: 36247879 PMCID: PMC9561913 DOI: 10.1016/j.tcr.2022.100710] [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: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Tracheobronchial injury (TBI) associated with penetrating injuries has various clinical symptoms and often requires urgent surgical repair. A tracheal tube and/or placement of a drainage tube combined with multidetector computed tomography (CT) could be used to manage TBI without surgical repair in eligible patients. In this case report, we describe an 86-year-old woman with subcutaneous emphysema and suspected TBI caused by three knife wounds in her neck. After tracheal intubation at a local hospital, she was transferred to our hospital. On admission, she was diagnosed with subcutaneous and mediastinal emphysema due to TBI, as well as bilateral pneumothorax. We adjusted the position of the tracheal tube to a distal location from the TBI, and placed bilateral thoracic drainage tubes by referring to the CT images taken on admission and during the follow-up. The follow-up CT images revealed healing of the TBI. She did not show any worsening of her symptoms and she was successfully extubated on day 10 of her hospital stay. On day 18, she was considered self-reliant and was transferred to her previous hospital. Based on our experience in this case, we believe that ventilation with appropriate sedation, placement of a tracheal tube, and drainage are important conservative therapies for TBI caused by penetrating injuries. CT is also useful for evaluating the status of TBI.
Collapse
Affiliation(s)
- Tsuyoshi Takahashi
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan,Corresponding author at: Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie 514-8507, Japan.
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Atsuya Hane
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Asami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Misato Suzumura
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koki Ueda
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mari Shinoda
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| |
Collapse
|
4
|
López-Cano M, García-Alamino JM, Antoniou SA, Bennet D, Dietz UA, Ferreira F, Fortelny RH, Hernandez-Granados P, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Pereira JA, Schwab R, Slater N, Vanlander A, Van Ramshorst GH, Berrevoet F. EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen. Hernia 2018; 22:921-939. [DOI: 10.1007/s10029-018-1818-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
|
5
|
Hobeika C, Allard MA, Bucur PO, Naili S, Sa Cunha A, Cherqui D, Castaing D, Adam R, Vibert E. Management of the Open Abdomen after Liver Transplantation. World J Surg 2018; 41:3199-3204. [PMID: 28717912 DOI: 10.1007/s00268-017-4125-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The optimal management of the open abdomen (OA) after liver transplantation (LT) is unclear. The negative pressure wound therapy (NPWT) has been shown to be safe and can increase the chance for early fascial closure in trauma or septic patients. However, little data are available on the specific setting of LT. We aimed to report our experience of OA after LT, marked by the recent use of NPWT. METHODS All patients with postponed wall closure after LT, from 2002 to 2014, in a single institution were included and retrospectively analyzed. Our management of OA after LT has shifted from skin-only closure (SOC) followed by abdominal wall reconstruction at a distance to the use of NPWT with early fascial closure. RESULTS Of the 1559 LTs performed during the study period, immediate abdominal wall closure at the end of transplantation could not be achieved in 46 (2.9%) patients. Of them, SOC was performed in 22 (47.8%) patients, whereas vacuum-assisted closure (VAC) therapy was used in 24 (52.1%) patients. The comprehensive complication indexes (CCI) were similar [CCI: 66 (0-100) in the SOC group vs. 56 (0-100) in the VAC group; p = 0.55]. No evisceration or fistula occurred in both groups. One (4.2%) postoperative bleeding case was reported in the VAC group. Early fascial closure was achieved within a median of 5.5 days (1-12) for the 24 patients (100%) of the VAC group. In four of them, a biological mesh was necessary. Only nine patients (52.9%) of the survivors in the SOC group underwent abdominal reconstruction. CONCLUSION The NPWT in patients with OA after LT enables early fascial closure with limited morbidity provided a specific attention is given to the risk of bleeding. These results support the use of NPWT as the first option in OA patients after LT.
Collapse
Affiliation(s)
- Christian Hobeika
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France
| | - Marc-Antoine Allard
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France. .,Université Paris-Sud, Villejuif, France. .,Institut National de la Santé et de la Recherche (INSERM) Unité 935, Paris, France.
| | - Petru-Octav Bucur
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,INSERM Unité 785, Paris, France
| | - Salima Naili
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Institut National de la Santé et de la Recherche (INSERM) Unité 935, Paris, France
| | - Daniel Cherqui
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,INSERM Unité 785, Paris, France
| | - Denis Castaing
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,INSERM Unité 785, Paris, France
| | - René Adam
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Institut National de la Santé et de la Recherche (INSERM) Unité 935, Paris, France
| | - Eric Vibert
- Centre Hépatobiliaire, Hôpital Paul Brousse, 14 av Paul Vaillant Couturier, 94800, Villejuif, France.,Université Paris-Sud, Villejuif, France.,INSERM Unité 785, Paris, France
| |
Collapse
|
6
|
Analysis for Patient Survival after Open Abdomen for Torso Trauma and the Impact of Achieving Primary Fascial Closure: A Single-Center Experience. Sci Rep 2018; 8:6213. [PMID: 29670226 PMCID: PMC5906612 DOI: 10.1038/s41598-018-24482-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/03/2018] [Indexed: 12/03/2022] Open
Abstract
Open abdomen indicates the abdominal fascia is unclosed to abbreviate surgery and to reduce physiological stress. However, complications and difficulties in patient care are often encountered after operation. During May 2008 to March 2013, we performed a prospective protocol-directed observation study regarding open abdomen use in trauma patients. Bogota bag is the temporary abdomen closure initially but negative pressure dressing is used later. A goal-directed ICU care is applied and primary fascial closure is the primary endpoint. There were 242 patients received laparotomy after torso trauma and 84 (34.7%) had open abdomen. Twenty patients soon died within one day and were excluded. Among the included 64 patients, there were 49 (76.6%) males and the mean Injury Severity Score was 31.7. Uncontrolled bleeding was the major indication for open abdomen (64.1%) and the average duration of open abdomen was about 4.2 ± 2.2 days. After treatment, 53(82.8%) had primary fascia closure, which is significant for patient survival (odds ratio 21.6; 95% confidence interval: 3.27–142, p = 0.0014). Factors related to failed primary fascia closure are profound shock during operation, high Sequential Organ Failure Assessment Score in ICU and inadequate urine amount at first 48 hours admission.
Collapse
|
7
|
Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma. Chin J Traumatol 2018; 21:118-121. [PMID: 29563058 PMCID: PMC5911732 DOI: 10.1016/j.cjtee.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/12/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023] Open
Abstract
Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.
Collapse
|
8
|
Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, Moore EE, Coimbra R, Kirkpatrick AW, Pereira BM, Montori G, Ceresoli M, Abu-Zidan FM, Sartelli M, Velmahos G, Fraga GP, Leppaniemi A, Tolonen M, Galante J, Razek T, Maier R, Bala M, Sakakushev B, Khokha V, Malbrain M, Agnoletti V, Peitzman A, Demetrashvili Z, Sugrue M, Di Saverio S, Martzi I, Soreide K, Biffl W, Ferrada P, Parry N, Montravers P, Melotti RM, Salvetti F, Valetti TM, Scalea T, Chiara O, Cimbanassi S, Kashuk JL, Larrea M, Hernandez JAM, Lin HF, Chirica M, Arvieux C, Bing C, Horer T, De Simone B, Masiakos P, Reva V, DeAngelis N, Kike K, Balogh ZJ, Fugazzola P, Tomasoni M, Latifi R, Naidoo N, Weber D, Handolin L, Inaba K, Hecker A, Kuo-Ching Y, Ordoñez CA, Rizoli S, Gomes CA, De Moya M, Wani I, Mefire AC, Boffard K, Napolitano L, Catena F. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg 2018; 13:7. [PMID: 29434652 PMCID: PMC5797335 DOI: 10.1186/s13017-018-0167-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023] Open
Abstract
Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
Collapse
Affiliation(s)
- Federico Coccolini
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Derek Roberts
- Department of Surgery, Foothills Medical Centre, Calgary, Canada
| | - Luca Ansaloni
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | | | - Bruno M. Pereira
- Faculdade de Ciências Médicas (FCM)–Unicamp Campinas, Campinas, SP Brazil
| | - Giulia Montori
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Marco Ceresoli
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - George Velmahos
- Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | | | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Matti Tolonen
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Joseph Galante
- Trauma and Acute Care Surgery and Surgical Critical Care Trauma, Department of Surgery, University of California, Davis, USA
| | - Tarek Razek
- General and Emergency Surgery, McGill University Health Centre, Montréal, QC Canada
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Miklosh Bala
- General Surgery Department, Hadassah Medical Centre, Jerusalem, Israel
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria
| | | | - Manu Malbrain
- ICU and High Care Burn Unit, Ziekenhius Netwerk Antwerpen, Antwerpen, Belgium
| | | | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | | | - Ingo Martzi
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie Universitätsklinikum Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Kjetil Soreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Walter Biffl
- Acute Care Surgery, The Queen’s Medical Center, Honolulu, HI USA
| | | | - Neil Parry
- General and Trauma Surgery Department, London Health Sciences Centre, Victoria Hospital, London, ON Canada
| | - Philippe Montravers
- Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France
| | - Rita Maria Melotti
- ICU Department, Sant’Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Salvetti
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Tino M. Valetti
- ICU Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Thomas Scalea
- Surgery Department, University of Maryland School of Medicine, Baltimore, MD USA
| | - Osvaldo Chiara
- Emergency and Trauma Surgery Department, Niguarda Hospital, Milano, Italy
| | | | - Jeffry L. Kashuk
- General Surgery Department, Assuta Medical Centers, Tel Aviv, Israel
| | - Martha Larrea
- General Surgery, “General Calixto García”, Habana Medicine University, Havana, Cuba
| | | | - Heng-Fu Lin
- Division of Trauma, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China
| | - Mircea Chirica
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Camilla Bing
- General and Emergency Surgery Department, Empoli Hospital, Empoli, Italy
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Orebro, Sweden
| | | | - Peter Masiakos
- Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Nicola DeAngelis
- Unit of Digestive Surgery, HPB Surgery and Liver Transplant, Henri Mondor Hospital, Créteil, France
| | - Kaoru Kike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Paola Fugazzola
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Matteo Tomasoni
- General Emergency and Trauma Surgery, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy
| | - Rifat Latifi
- General Surgery Department, Westchester Medical Center, Westchester, NY USA
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia & The University of Newcastle, Perth, Australia
| | - Lauri Handolin
- Trauma Unit, Helsinki University Hospital, Helsinki, Finland
| | - Kenji Inaba
- Division of Trauma and Critical Care, LAC+USC Medical Center, University of Southern California, California, Los Angeles USA
| | - Andreas Hecker
- General and Thoracic Surgery, Giessen Hospital, Giessen, Germany
| | - Yuan Kuo-Ching
- Acute Care Surgery and Traumatology, Taipei Medical University Hospital, Taipei City, Taiwan, Republic of China
| | - Carlos A. Ordoñez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Sandro Rizoli
- Trauma and Acute Care Service, St Michael’s Hospital, Toronto, ON Canada
| | - Carlos Augusto Gomes
- Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Marc De Moya
- Trauma, Acute Care Surgery, Medical College of Wisconsin/Froedtert Trauma Center, Milwaukee, WI USA
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Alain Chichom Mefire
- Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Ken Boffard
- Milpark Hospital Academic Trauma Center, University of the Witwatersrand, Johannesburg, South Africa
| | - Lena Napolitano
- Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI USA
| | - Fausto Catena
- Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy
| |
Collapse
|
9
|
Vacuum-Assisted Abdominal Closure Is Safe and Effective: A Cohort Study in 74 Consecutive Patients. Surg Res Pract 2017; 2017:7845963. [PMID: 29085880 PMCID: PMC5612310 DOI: 10.1155/2017/7845963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/10/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Vacuum-assisted closure (VAC) has, in many instances, become the treatment of choice in patients with abdominal catastrophes. This study describes the use and outcome of ABThera KCI® VAC in the Region Southern Denmark covering a population of approximately 1.202 mill inhabitants. METHOD A prospective multicenter study including all patients treated with VAC during an eleven-month period. RESULTS A total of 74 consecutive patients were included. Median age was 64.4 (9-89) years, 64% were men, and median body mass index was 25 (17-42). Duration of VAC treatment was median 4.5 (0-39) days with median 1 (0-16) dressing changes. Seventy per cent of the patients attended the intensive care unit. The 90-day mortality was 15%. A secondary closure of the fascia was obtained in 84% of the surviving patients. Only one patient developed an enteroatmospheric fistula. Patients with secondary closure were less likely to develop large hernias and had better self-evaluated physical health score (p < 0,05). No difference in mental health was found. CONCLUSION The abdominal VAC treatment in patients with abdominal catastrophes is safe and with a relative low complication rate. Whether it might be superior to conventional treatment with primary closure when possible has yet to be proven in a randomized study.
Collapse
|
10
|
Coccolini F, Montori G, Ceresoli M, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, Coimbra R, Rizoli S, Kluger Y, Abu-Zidan FM, Sartelli M, De Moya M, Velmahos G, Fraga GP, Pereira BM, Leppaniemi A, Boermeester MA, Kirkpatrick AW, Maier R, Bala M, Sakakushev B, Khokha V, Malbrain M, Agnoletti V, Martin-Loeches I, Sugrue M, Di Saverio S, Griffiths E, Soreide K, Mazuski JE, May AK, Montravers P, Melotti RM, Pisano M, Salvetti F, Marchesi G, Valetti TM, Scalea T, Chiara O, Kashuk JL, Ansaloni L. The role of open abdomen in non-trauma patient: WSES Consensus Paper. World J Emerg Surg 2017; 12:39. [PMID: 28814969 PMCID: PMC5557069 DOI: 10.1186/s13017-017-0146-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/25/2017] [Indexed: 12/19/2022] Open
Abstract
The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.
Collapse
Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Marco Ceresoli
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Parma Maggiore hospital, Parma, Italy
| | | | - Rao Ivatury
- Trauma Surgery, Virginia Commonwealth University, Richmond, VA 23284 USA
| | - Walter Biffl
- Acute Care Surgery, The Queen’s Medical Center, Honolulu, HI 96813 USA
| | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, 15213 USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, 92103 USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael’s Hospital, Toronto, ON Canada
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Marc De Moya
- Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114 USA
| | - George Velmahos
- Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114 USA
| | | | - Bruno M. Pereira
- Faculdade de Ciências Médicas (FCM) – Unicamp Campinas, São Paulo, Brazil
| | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | | | | | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, 98104 USA
| | - Miklosh Bala
- General Surgery Department, Hadassah Medical Centre, Jerusalem, Israel
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria
| | | | - Manu Malbrain
- ICU and High Care Burn Unit, Ziekenhius Netwerk Antwerpen, Antwerpen, Belgium
| | | | | | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | | | - Ewen Griffiths
- Upper Gatrointestinal Surgery, Birmigham Hospital, Birmigham, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - John E. Mazuski
- Department of Surgery, School of Medicine, Washington University, Saint Louis, MO 63130 USA
| | - Addison K. May
- Departments of Surgery and Anesthesiology, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Philippe Montravers
- Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, Paris, France
| | | | - Michele Pisano
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Francesco Salvetti
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | | | - Tino M. Valetti
- ICU Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Thomas Scalea
- Trauma Surgery department, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Osvaldo Chiara
- Emergency and Trauma Surgery department, Niguarda Hospital, Milan, Italy
| | - Jeffry L. Kashuk
- General Surgery department, Assuta Medical Centers, Tel Aviv, Israel
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery dept., Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| |
Collapse
|
11
|
Casal D, Pelliccia G, Pais D, Carrola-Gomes D, Angélica-Almeida M, Videira-Castro J, Goyri-O'Neill J. Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report. J Med Case Rep 2017; 11:205. [PMID: 28754171 PMCID: PMC5534056 DOI: 10.1186/s13256-017-1361-9] [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: 01/16/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. Case presentation A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. Conclusions This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.
Collapse
Affiliation(s)
- Diogo Casal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
| | - Giovanni Pelliccia
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Pais
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Carrola-Gomes
- General Surgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Angélica-Almeida
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - José Videira-Castro
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| |
Collapse
|
12
|
Willms A, Schaaf S, Schwab R, Richardsen I, Jänig C, Bieler D, Wagner B, Güsgen C. Intensive care and health outcomes of open abdominal treatment: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). Langenbecks Arch Surg 2017; 402:481-492. [PMID: 28382564 DOI: 10.1007/s00423-017-1575-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/08/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE The study's purpose is to evaluate the long-term outcome after vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) and to identify predictors of quality of life associated with intensive care. METHODS Fifty-five patients who underwent open abdomen management at our institution from 2006 to 2013 were prospectively enrolled in this study. After a median follow-up period of 3.8 years, 27 patients completed the 36-Item Short Form Survey (SF-36) quality of life questionnaire. As this is a report solely focused on quality of life, direct treatment-related outcome measures like mortality, closure rates, and incisional hernia development of this study cohort have been reported previously. RESULTS = 0.50, β = -0.70, p = 0.02). CONCLUSIONS Despite high short-term mortality and morbidity rates for these critically ill patients, open abdomen treatment using VAWCM allows patients to recover to an acceptable long-term quality of life. The complex intensive care score can be used as a surrogate parameter for the global severity of illness and was the only predictor of physical functioning (SF-36).
Collapse
Affiliation(s)
- A Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
| | - S Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| | - I Richardsen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| | - C Jänig
- Department of Anesthesiology and Intensive Care, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| | - D Bieler
- Department of Trauma Surgery and Orthopedics, Plastic and Reconstructive Surgery, and Hand Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| | - B Wagner
- Support Division of the Directorate-General for Strategy and Operations, Federal Ministry of Defense, Berlin, Germany
| | - C Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany
| |
Collapse
|
13
|
Willms A, Muysoms F, Güsgen C, Schwab R, Lock J, Schaaf S, Germer C, Richardsen I, Dietz U. The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications. Hernia 2017; 21:279-289. [PMID: 28093615 DOI: 10.1007/s10029-017-1572-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/05/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Open abdomen management has become a well-established strategy in the treatment of serious intra-abdominal pathologies. Key objectives are fistula prevention and high fascial closure rates. The current level of evidence on laparostoma is insufficient. This is due to the rareness of laparostomas, the heterogeneity of study cohorts, and broad diversity of techniques. Collecting data in a standardised, multicentre registry is necessary to draw up evidence-based guidelines. MATERIALS AND METHODS In order to improve the level of evidence on laparostomy, CAMIN (surgical working group for military and emergency surgery) of DGAV (German Society for General and Visceral Surgery), initiated the implementation of a laparostomy registry. This registry was established as the Open Abdomen Route by EuraHS (European Registry of Abdominal Wall Hernias). Key objectives include collection of data, quality assurance, standardisation of therapeutic concepts and the development of guidelines. Since 1 May 2015, the registry is available as an online database called Open Abdomen Route of EuraHS (European Registry of Abdominal Wall Hernias). It includes 11 categories for data collection, including three scheduled follow-up examinations. RESULTS As part of this pilot study, all entries of the first 120 days were analysed, resulting in a review of 82 patients. At 44%, secondary peritonitis was the predominant indication. The mortality rate was 22%. A comparison of methods with and without fascial traction reveals fascial closure rates of 67% and 25%, respectively (intention-to-treat analysis, p < 0.03). Inert visceral protection was used in 67% of patients and achieved a small bowel fistula incidence of only 5.5%. DISCUSSION Optimising laparostomy management techniques in order to achieve low incidence of fistulation and high fascial closure rates is possible. The method that ensures the best possible outcome-based on current evidence-would involve fascial traction, visceral protection and negative pressure. The laparostomy registry is a useful tool for quickly generating sufficient evidence for open abdomen treatment.
Collapse
Affiliation(s)
- A Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
| | - F Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs, 30, Ghent, Belgium
| | - C Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - R Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - J Lock
- Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany
| | - S Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - C Germer
- Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany
| | - I Richardsen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - U Dietz
- Department of General, Visceral and Transplantation Surgery, University Hospital, Würzburg, Germany
| |
Collapse
|
14
|
Khasawneh MA, Zielinski MD. Optimum Methods for Keeping the Abdomen Open. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Nonfatal Cervical-Neck Lesion With a Wooden Foreign Body: Diagnosis and Management. J Craniofac Surg 2016; 27:175-6. [PMID: 26674918 DOI: 10.1097/scs.0000000000002338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Penetrating cervical lesions caused by a foreign body are rare events. The neck is a complex and delicate body region, given the important vascular structures it holds. The most frequent fatal complications often involve vascular injuries, and as a consequence, the mortality rate increases by approximately 50%. Civilian patients are mainly victims of violence or motor vehicle accidents and rural accidents involving neck are not very common. When a cervical lesion is because of a wooden foreign body, infectious risk increases for its organic peculiarity. The authors report a rural nonfatal cervical lesion in a civilian, and its management.
Collapse
|
16
|
Bensley RP, Mohr AM, Huber TS, Sappenfield JW. Novel use of a Sengstaken-Blakemore tube during a neck exploration of a carotid injury: A case report. Injury 2016; 47:2048-50. [PMID: 27017451 DOI: 10.1016/j.injury.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 02/02/2023]
Abstract
Penetrating neck trauma can injure the major blood vessels, airway, gastrointestinal system, and neurological system. We present a case where a Sengstaken-Blakemore tube was emergently placed during surgical exploration of a stab wound to the neck to tamponade bleeding until surgical control was obtained and the vascular injuries were managed.
Collapse
Affiliation(s)
- Rodney P Bensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas S Huber
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joshua W Sappenfield
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
17
|
Bodanapally UK, Shanmuganathan K, Dreizin D, Stein D, Reddy AK, Mirvis SE, Vasquez M, Cardarelli C, Guardiani E. Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm. Eur Radiol 2015; 26:2409-17. [DOI: 10.1007/s00330-015-4050-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/15/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
|
18
|
Sartelli M, Abu-Zidan FM, Ansaloni L, Bala M, Beltrán MA, Biffl WL, Catena F, Chiara O, Coccolini F, Coimbra R, Demetrashvili Z, Demetriades D, Diaz JJ, Di Saverio S, Fraga GP, Ghnnam W, Griffiths EA, Gupta S, Hecker A, Karamarkovic A, Kong VY, Kafka-Ritsch R, Kluger Y, Latifi R, Leppaniemi A, Lee JG, McFarlane M, Marwah S, Moore FA, Ordonez CA, Pereira GA, Plaudis H, Shelat VG, Ulrych J, Zachariah SK, Zielinski MD, Garcia MP, Moore EE. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg 2015; 10:35. [PMID: 26269709 PMCID: PMC4534034 DOI: 10.1186/s13017-015-0032-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/03/2015] [Indexed: 02/07/2023] Open
Abstract
The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.
Collapse
Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Walter L. Biffl
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA
| | - Fausto Catena
- Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Osvaldo Chiara
- Emergency Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | | | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Science, San Diego, USA
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Demetrios Demetriades
- Trauma, Emergency Surgery, Surgical Critical Care, University of Southern California, Los Angeles, USA
| | - Jose J. Diaz
- Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | | | - Gustavo P. Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Wagih Ghnnam
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sanjay Gupta
- Department of Surgery Government Medical College and Hospital, Chandigarh, India
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | | | - Victor Y. Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Thorax and Transplant Surgery, University of Innsbruck, Innsbruck, Austria
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Rifat Latifi
- Department of Surgery, Trauma Research Institute, University of Arizona, Tucson, AZ USA
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Michael McFarlane
- Department of Surgery, University Hospital of the West Indies, Kingston, Jamaica
| | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | | | - Carlos A. Ordonez
- Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Gerson Alves Pereira
- Division of Emergency and Trauma Surgery, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Haralds Plaudis
- Department of General and Emergency Surgery, Riga East Clinical University Hospital “Gailezers”, Riga, Latvia
| | - Vishal G. Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jan Ulrych
- 1st Surgical Department of First Faculty of Medicine, General University Hospital, Prague Charles University, Prague, Czech Republic
| | | | | | - Maria Paula Garcia
- Centro de investigaciones clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA
| |
Collapse
|
19
|
Marinis A, Gkiokas G, Argyra E, Fragulidis G, Polymeneas G, Voros D. "Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg 2014; 102:61-8. [PMID: 23820678 DOI: 10.1177/1457496913482252] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.
Collapse
Affiliation(s)
- A Marinis
- First Department of Surgery, Tzaneion General Hospital, Piraeus, Greece
| | | | | | | | | | | |
Collapse
|
20
|
De Siqueira J, Tawfiq O, Garner J. Managing the open abdomen in a district general hospital. Ann R Coll Surg Engl 2014; 96:194-8. [PMID: 24780782 DOI: 10.1308/003588414x13814021678556] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The need to manage an open abdomen is becoming more common in general surgical practice and a variety of methods of temporary abdominal closure (TAC) are available. The evidence for the efficacy of the various forms of TAC as well as the subsequent definitive fascial closure (DFC) rates and complications comes mainly from large trauma series in the US, which represent a different patient population to those in the UK in whom TAC is usually required. METHODS All cases of open abdomen management in our hospital over a five-year period were reviewed to ascertain the methods of TAC used, our success in achieving DFC and the applicability of managing such cases in a district hospital environment. RESULTS Nineteen patients underwent TAC, with two deaths (10.5%) and an overall DFC rate at hospital discharge of 12/17 (70.6%). The median lengths of critical care and hospital stays were 19.5 and 38.0 days respectively. Thirteen out of seventeen survivors had at least one significant complication. CONCLUSIONS The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.
Collapse
|
21
|
Imaging of penetrating injuries of the head and neck:current practice at a level I trauma center in the United States. Keio J Med 2014; 63:23-33. [PMID: 24965876 DOI: 10.2302/kjm.2013-0009-re] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Penetrating neck injuries are commonly related to stab wounds and gunshot wounds in the United States. The injuries are classified by penetration site in terms of the three anatomical zones of the neck. Based on this zonal classification system, penetrating injuries to the head and neck have traditionally been evaluated by conventional angiography and/or surgical exploration. In recent years, multidetector-row computed tomography (CT) angiography has significantly improved detectability of vascular injuries and extravascular injuries in the setting of penetrating injuries. CT angiography is a fast and minimally invasive imaging modality to evaluate penetrating injuries of the head and neck for stable patients. The spectrum of penetrating neck injuries includes vascular injury (extravasation, pseudoaneurysm, dissection, occlusion, and arteriovenous fistula), aerodigestive injury (esophageal and tracheal injuries), salivary gland injury, neurologic injury (spinal canal and cerebral injuries), and osseous injury, all of which can be evaluated using CT angiography. Familiarity with the complications and imaging characteristics of penetrating injuries of the head and neck is essential for accurate diagnosis and optimal treatment.
Collapse
|
22
|
Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2014; 2014:784056. [PMID: 24987411 PMCID: PMC4060535 DOI: 10.1155/2014/784056] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/15/2014] [Indexed: 01/08/2023] Open
Abstract
Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.
Collapse
|
23
|
Rausei S, Dionigi G, Boni L, Rovera F, Minoja G, Cuffari S, Dionigi R. Open Abdomen Management of Intra-Abdominal Infections: Analysis of a Twenty-Year Experience. Surg Infect (Larchmt) 2014; 15:200-6. [DOI: 10.1089/sur.2012.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Stefano Rausei
- Department of Surgery, University of Insubria, Varese, Italy
| | | | - Luigi Boni
- Department of Surgery, University of Insubria, Varese, Italy
| | | | - Giulio Minoja
- Department of Critical Care Medicine, University of Insubria, Varese, Italy
| | | | - Renzo Dionigi
- Department of Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
24
|
Kobayashi L, Coimbra R. Planned re-laparotomy and the need for optimization of physiology and immunology. Eur J Trauma Emerg Surg 2014; 40:135-42. [PMID: 26815893 DOI: 10.1007/s00068-014-0396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/10/2014] [Indexed: 12/31/2022]
Abstract
Planned re-laparotomy or damage control laparotomy (DCL), first described by Dr. Harlan Stone in 1983, has become a widely utilized technique in a broad range of patients and operative situations. Studies have validated the use of DCL by demonstrating decreased mortality and morbidity in trauma, general surgery and abdominal vascular catastrophes. Indications for planned re-laparotomy include severe physiologic derangements, coagulopathy, concern for bowel ischemia, and abdominal compartment syndrome. The immunology of DCL patients is not well described in humans, but promising animal studies suggest a benefit from the open abdomen (OA) and several human trials on this subject are currently underway. Optimal critical care of patients with OA's, including sedation, paralysis, nutrition, antimicrobial and fluid management strategies have been associated with improved closure rates and recovery.
Collapse
Affiliation(s)
- L Kobayashi
- Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California, San Diego, 200 W. Arbor Dr. #8896, San Diego, CA, 92103-8896, USA.
| | - R Coimbra
- Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California, San Diego, 200 W. Arbor Dr. #8896, San Diego, CA, 92103-8896, USA.
| |
Collapse
|
25
|
Godat L, Kobayashi L, Costantini T, Coimbra R. Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper. World J Emerg Surg 2013; 8:53. [PMID: 24341602 PMCID: PMC3878509 DOI: 10.1186/1749-7922-8-53] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 12/02/2022] Open
Abstract
Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure.
Collapse
Affiliation(s)
| | | | | | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, and Burns, University of California, San Diego, 200 West Arbor Dr,, #8896, San Diego CA 92103-8896, United States of America.
| |
Collapse
|
26
|
Frazee RC, Abernathy S, Jupiter D, Davis M, Regner J, Isbell T, Smith R. Long-term consequences of open abdomen management. TRAUMA-ENGLAND 2013. [DOI: 10.1177/1460408613507686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background There is little data on the long-term results of the open abdomen technique regarding subsequent bowel obstruction, enterocutaneous fistula and ventral hernia rates. This study represents our follow-up of these complications. Methods A retrospective review of patients undergoing open abdomen management was performed. Patient demographics and development of subsequent ventral hernia, enteric fistula and/or bowel obstruction were evaluated. Results Seventy-three men and 47 women with a mean age of 51 underwent open abdomen management; 85 for inflammatory conditions and 35 for haemorrhagic conditions. Only 27 patients did not achieve definitive fascial closure and were left open for secondary closure or had a biologic mesh bridge; 13 patients had component separation to achieve fascial closure. With a mean follow-up of 21 months, 30 patients (25%) developed a ventral hernia, 13 patients (11%) experienced an enterocutaneous fistula and two patients developed bowel obstruction. Ventral hernias and enterocutaneous fistulae occurred in 78% and 41%, respectively, of patients not definitively closed compared with 10% and 2%, respectively, of patients closed primarily at initial management ( p < 0.05). Conclusions There is a high incidence of ventral hernia and enterocutaneous fistula when open abdomen management necessitates leaving the abdomen open or using a biologic mesh bridge. Strategies for primary fascia closure including component separation should be employed.
Collapse
Affiliation(s)
- Richard C Frazee
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Stephen Abernathy
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Daniel Jupiter
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Matthew Davis
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Justin Regner
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Travis Isbell
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Randall Smith
- Trauma Surgery, Scott & White Healthcare, Temple, TX, USA
- Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| |
Collapse
|
27
|
Abstract
OBJECTIVES To 1) review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; 2) provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; 3) summarize the evidence for early mobilization in each anatomic area; and 4) provide recommendations for the mobilization of these patients. DATA SOURCES A literature search of the MEDLINE and EMBASE databases for articles published in English between 1980 and 2011. STUDY SELECTION Studies pertaining to physical therapy and rehabilitation in trauma patients were selected. Articles were excluded if they dealt with pediatrics, geriatrics, burn injuries, isolated hand injuries, chronic (i.e., not acute) injuries, nontraumatic conditions, and pressure/decubitus ulcers, were in a language other than English, were published only in abstract form, were letters to the editor, were case reports, or were published prior to 1980. DATA EXTRACTION Reviewers extracted data and summarized results according to anatomical areas. DATA SYNTHESIS Of 1,411 titles and abstracts, 103 met inclusion criteria. We found no articles specifically addressing the rehabilitation of polytrauma patients in the ICU setting or patients with polytrauma in general. We summarized the articles addressing the role of mobilization for specific injuries and treatments. We used this evidence, in combination with biologic rationale and physician and surgeon experience and expertise, to summarize the important considerations when providing physical therapy to these patients in the ICU setting. CONCLUSIONS There is a paucity of evidence addressing the role of early mobilization of ICU patients with polytrauma and patients with polytrauma in general. Evidence for the beneficial role of early mobilization of specific injuries exists. Important considerations when applying a strategy of early physical therapy and mobilization to this distinctive patient group are summarized.
Collapse
|
28
|
Kreis BE, de Mol van Otterloo AJ, Kreis RW. Open abdomen management: a review of its history and a proposed management algorithm. Med Sci Monit 2013; 19:524-33. [PMID: 23823991 PMCID: PMC3706408 DOI: 10.12659/msm.883966] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/10/2013] [Indexed: 12/13/2022] Open
Abstract
In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic.
Collapse
|
29
|
Soliman AMS, Ahmad SM, Roy D. The role of aerodigestive tract endoscopy in penetrating neck trauma. Laryngoscope 2012; 124 Suppl 7:S1-9. [PMID: 23070927 DOI: 10.1002/lary.23611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS To determine the role of aerodigestive tract endoscopy in the management of penetrating neck trauma. STUDY DESIGN Retrospective case series. METHODS A search of the hospital's trauma database was performed for patients who presented with penetrating neck trauma between July 1989 and June 2008. The mechanism and site of injury, airway status and manipulation, physical findings, diagnostic and therapeutic steps taken, and outcomes were all recorded. RESULTS One hundred sixty-three patients were identified. There were 144 males and 19 females. The mean age was 28 years (range, 13 to 65 years). There were 105 gunshot wounds, 9 shotgun injuries, and 48 stab wounds. Seventy-three patients (45%) underwent emergent neck exploration, of which 15 had upper aerodigestive tract injuries; intraoperative endoscopy was performed on 13 and was used to guide the repair. Ninety patients (55%) did not meet the criteria for emergent neck exploration. Endoscopy in this group was performed in symptomatic patients, which revealed two cases of unilateral true vocal fold motion impairment, one mucosal laceration of the right mainstem bronchus, one questionable area of injury at the apical segment of the right upper lobe bronchus, and one mucosal laceration of the proximal esophagus. CONCLUSIONS Aerodigestive tract endoscopy is critical in assessing and guiding surgical repair of injuries noted on surgical exploration. In stable patients with a low clinical suspicion of aerodigestive tract injury, it was of low yield. We propose a new algorithm for assessing aerodigestive tract injuries that includes multidetector computed tomography, in which only symptomatic patients who fail to meet the criteria for emergent neck exploration undergo endoscopy. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Ahmed M S Soliman
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | | | | |
Collapse
|
30
|
Abstract
Since the mid-1990s the surgical community has seen a surge in the prevalence of open abdomens (OAs) reported in the surgical literature and in clinical practice. The OA has proven to be effective in decreasing mortality and immediate postoperative complications; however, it may come at the cost of delayed morbidity and the need for further surgical procedures. Indications for leaving the abdomen open have broadened to include damage control surgery, abdominal compartment syndrome, and abdominal sepsis. The surgical options for management of the OA are now more diverse and sophisticated, but there is a lack of prospective randomized controlled trials demonstrating the superiority of any particular method. Additionally, critical care strategies for optimization of the patient with an OA are still being developed. Review of the literature suggests a bimodal distribution of primary closure rates, with early closure dependent on postoperative intensive care management and delayed closure more affected by the choice of the temporary abdominal closure technique. Invariably, a small fraction of patients requiring OA management fail to have primary fascial closure and require some form of biologic fascial bridge with delayed ventral hernia repair in the future.
Collapse
|
31
|
Abstract
Enteroatmospheric fistula (EAF), a special subset of enterocutaneous fistula (ECF), is defined as a communication between the gastrointestinal (GI) tract and the atmosphere. It is one of the most devastating complications of "damage control" laparotomy (DCL) and results in significant morbidity and mortality. The published incidence of EAF ranges from 5%-19% of patients who have undergone DCL and survived long enough to develop complications. Their etiology is complex and ranges from persistent abdominal infection, anastomotic leakage, adhesions of the bowel to itself or fascia, and repeated bowel manipulation during return trips to the operating room or dressing changes. Prevention is clearly the best treatment strategy but may be difficult to achieve. Once an EAF occurs, immediate management consists of treatment of sepsis if present; nutrition, fluid, and electrolyte support in the form of parenteral nutrition (PN); and wound/effluent control and protection of surrounding tissues and exposed bowel. It should be noted that EAF almost never close spontaneously, and definitive repair usually requires major surgical intervention and abdominal wall reconstruction 6 to 12 months after the original insult. Enteral feeding should be attempted once the anatomy of the EAF is defined and reliable enteral access is obtained. Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone. Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF.
Collapse
Affiliation(s)
- Sarah Majercik
- Sarah Majercik, MBA, Department of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT 84157, USA.
| | | | | |
Collapse
|
32
|
Verdam FJ, Dolmans DEJGJ, Loos MJ, Raber MH, de Wit RJ, Charbon JA, Vroemen JPAM. Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg 2012; 35:2348-55. [PMID: 21850603 PMCID: PMC3170463 DOI: 10.1007/s00268-011-1210-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The major challenge in the management of patients with an infected open abdomen (OA) is to control septic peritonitis and intra-abdominal fluid secretion, and to facilitate repeated abdominal exploration, while preserving the fascia for delayed primary closure. We here present a novel method for closure of the infected OA, based on continuous dynamic tension, in order to achieve re-approximation of the fascial edges of the abdominal wall. Methods Eighteen cases with severe peritonitis of various origin (e.g., gastrointestinal perforations, anastomotic leakage) were primarily stabilized by laparostomy, sealed with either the vacuum-assisted closure abdominal dressing or the Bogotá bag. After hemodynamic stabilization and control of the sepsis, the Abdominal Re-approximation Anchor System (ABRA; Canica Design, Almonte, Ontario, Canada) was applied. This system approximates the wound margins through dynamic traction exerted by transfascial elastomers. Before ABRA application, 5/18 patients had a grade 2B, 2/18 a grade 3, and 11/18 a grade or 4 status according to the open abdomen classification of Björck. Results In this severely ill population the mean time before ABRA system application was 12 days (range: 2–39 days). Two of 18 patients died of non-ABRA-related causes within three weeks. In 14 of the remaining 16 patients (88%) primary abdominal closure of the midline was accomplished in 15 days (range: 7–30 days). The other two patients needed a component separation technique according to Ramirez to reach closure. However, secondary wound dehiscence occurred in both these patients. Two thirds of patients (12/18) developed pressure sores to the skin and/or dermis, but all healed without further complications. During outpatient clinic follow-up, 4/14 successfully closed patients still developed a midline hernia. Conclusions Delayed primary closure of OA in septic patients could be achieved in 88% with this new approximation system. However, the risk of hernia development remained. We consider this system a useful tool in the treatment of septic patients with an open abdomen. Electronic supplementary material The online version of this article (doi:10.1007/s00268-011-1210-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK Breda, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
33
|
Vascular surgery for penetrating injury of the neck*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
34
|
Ferguson EJ, Oswanski MF, Stombaugh HA, Daniels RG. Early Definitive Closure of Abdomen Using Components Separation Technique after Damage Control Surgery. Am Surg 2011. [DOI: 10.1177/000313481107700407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J. Ferguson
- Trauma Services The Toledo Hospital & Toledo Children's Hospital Toledo, Ohio
| | - Michael F. Oswanski
- Trauma Services The Toledo Hospital & Toledo Children's Hospital Toledo, Ohio
| | | | | |
Collapse
|
35
|
Kolber MR, Aspler A, Sequeira R. Conservative management of laryngeal perforation in a rural setting: case report and review of the literature on penetrating neck injuries. CAN J EMERG MED 2011; 13:127-32. [PMID: 21435319 DOI: 10.2310/8000.2011.110227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Penetrating neck injuries (PNIs) are infrequent but can result in significant morbidity and mortality. Although surgical management of unstable patients with penetrating neck trauma is the standard of care, management of stable patients remains controversial owing to the possibility of occult injuries. Recent studies suggest that physical examination and ancillary imaging may be sufficiently accurate to diagnose or rule out surgically significant injuries in PNI. We report a patient with a laryngeal perforation who was managed conservatively in a rural hospital without complications and review the literature pertinent to cases of this nature.
Collapse
Affiliation(s)
- Michael R Kolber
- Department of Family Medicine, University of Alberta, Edmonton, AB.
| | | | | |
Collapse
|
36
|
|
37
|
Abstract
Damage control surgery, initially formalized <20 yrs ago, was developed to overcome the poor outcomes in exsanguinating abdominal trauma with traditional surgical approaches. The core concepts for damage control of hemorrhage and contamination control with abbreviated laparotomy followed by resuscitation before definitive repair, although simple in nature, have led to an alteration in which emergent surgery is handled among a multitude of problems, including abdominal sepsis and battlefield surgery. With the aggressive resuscitation associated with damage control surgery, understanding of abdominal compartment syndrome has expanded. It is probably through avoiding this clinical entity that the greatest improvement in surgical outcomes for various emergent surgical problems has occurred in the past two decades. However, with its success, new problems have emerged, including increases in enterocutaneous fistulas and open abdomens. But as with any crisis, innovative strategies are being developed. New approaches to control of the open abdomen and reconstruction of the abdominal wall are being developed from negative pressure dressing therapies to acellular allograft meshes. With further understanding of new resuscitative strategies, the need for damage control surgery may decline, along with its concomitant complications, at the same time retaining the success that damage control surgery has brought to the critically ill trauma and general surgery patient in the past few years.
Collapse
|
38
|
Abstract
There are few complications dreaded more by the general surgeon than the development of an enteroatmospheric fistula in the face of the open abdomen. The open abdomen has become a valuable tool in the treatment of trauma and complex surgical patients. The development of enteroatmospheric fistulae leads to increased cost, morbidity, and mortality. In our case series, we describe the use of Malecot catheters and early mobilization of skin and subcutaneous tissue flaps to manage enteroatmospheric fistulae. All of our patients were discharged from the hospital and did not develop any complications from the procedure. All of our patients’ fistulae ultimately closed. This procedure could lead to decreased cost and morbidity.
Collapse
Affiliation(s)
- Philip T. Ramsay
- Department of Surgery, University of Tennessee College of Medicine—Chattanooga Unit, Chattanooga, Tennessee
| | - Vicente A. Mejia
- Department of Surgery, University of Tennessee College of Medicine—Chattanooga Unit, Chattanooga, Tennessee
| |
Collapse
|