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Alqazzaz A, Naseer Z, Beyer CA, Cannon JW, Khalsa A. Treatment approach for coexisting chest wall fractures and unstable thoracolumbar spine fractures in polytrauma patients requiring prone spine surgery. Trauma Surg Acute Care Open 2024; 9:e001196. [PMID: 38529315 PMCID: PMC10961491 DOI: 10.1136/tsaco-2023-001196] [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: 07/12/2023] [Accepted: 12/31/2023] [Indexed: 03/27/2024] Open
Abstract
Concomitant chest wall fractures (sternal and/or rib fractures) with unstable thoracolumbar fractures that require surgical fixation are rare but highly morbid injuries that mandate a multidisciplinary approach to treatment. There is limited evidence in the literature regarding optimal timing and order of surgical fixation of these patients with multiple injuries. Here, we present our experience with two patients at a single institution that demonstrates the challenges that present with this patient population. We advocate for earlier fixation of the chest wall fractures in the appropriately indicated patients, prior to prone positioning for spinal fixation.
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Affiliation(s)
- Aymen Alqazzaz
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zan Naseer
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Carl A Beyer
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amrit Khalsa
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Charron PN, Garcia LM, Tahir I, Floreani RA. Bio-inspired green light crosslinked alginate-heparin hydrogels support HUVEC tube formation. J Mech Behav Biomed Mater 2022; 125:104932. [PMID: 34736027 PMCID: PMC8665038 DOI: 10.1016/j.jmbbm.2021.104932] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 01/03/2023]
Abstract
Alginate is a polysaccharide which forms hydrogels via ionic and/or covalent crosslinking. The goal was to develop a material with suitable, physiologically relevant mechanical properties and biological impact for use in wound treatment. To determine if the novel material can initiate tube formation on its own, without the dependance on the addition of growth factors, heparin and/or arginyl-glycyl-aspartic acid (RGD) was covalently conjugated onto the alginate backbone. Herein, cell adhesion motifs and bioactive functional groups were incorporated covalently within alginate hydrogels to study the: 1) impact of crosslinked heparin on tubular network formation, 2) impact of RGD conjugation, and the 3) biological effect of vascular endothelial growth factor (VEGF) loading on cellular response. We investigated the structure-properties-function relationship and determined the viscoelastic and burst properties of the hydrogels most applicable for use as a healing cell and tissue adhesive material. Methacrylation of alginate and heparin hydroxyl groups respectively enabled free-radical covalent inter- and intra-molecular photo-crosslinking when exposed to visible green light in the presence of photo-initiators; the shear moduli indicate mechanical properties comparable to clinical standards. RGD was conjugated via carbodiimide chemistry at the alginate carboxyl groups. The adhesive and mechanical properties of alginate and alginate-heparin hydrogels were determined via burst pressure testing and rheology. Higher burst pressure and material failure at rupture imply physical tissue adhesion, advantageous for a tissue sealant healing material. After hydrogel formation, human umbilical vein endothelial cells (HUVECs) were seeded onto the alginate-based hydrogels; cytotoxicity, total protein content, and tubular network formation were assessed. Burst pressure results indicate that the cell responsive hydrogels adhere to collagen substrates and exhibit increased strength under high pressures. Furthermore, the results show that the green light crosslinked alginate-heparin maintained cell adhesion and promoted tubular formation.
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Affiliation(s)
| | - Luis M Garcia
- Department of Electrical and Biomedical Engineering, Burlington, VT, USA
| | - Irfan Tahir
- Department of Mechanical Engineering, Burlington, VT, USA
| | - Rachael A Floreani
- Department of Mechanical Engineering, Burlington, VT, USA; Department of Electrical and Biomedical Engineering, Burlington, VT, USA; Materials Science Program, University of Vermont, Burlington, VT, USA.
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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Fenn SL, Charron PN, Oldinski RA. Anticancer Therapeutic Alginate-Based Tissue Sealants for Lung Repair. ACS APPLIED MATERIALS & INTERFACES 2017; 9:23409-23419. [PMID: 28648052 PMCID: PMC5546308 DOI: 10.1021/acsami.7b04932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Injury to the connective tissue that lines the lung, the pleura, or the lung itself can occur from many causes including trauma or surgery, as well as lung diseases or cancers. To address current limitations for patching lung injuries, to stop air or fluid leaks, an adherent hydrogel sealant patch system was developed, based on methacrylated alginate (AMA) and AMA dialdehyde (AMA-DA) blends, which is capable of sealing damaged tissues and sustaining physiological pressures. Methacrylation of alginate hydroxyl groups rendered the polysaccharide capable of photo-cross-linking when mixed with an eosin Y-based photoinitiator system and exposed to visible green light. Oxidation of alginate yields functional aldehyde groups capable of imine bond formation with proteins found in many tissues. The alginate-based patch system was rigorously tested on a custom burst pressure testing device. Blending of nonoxidized material with oxidized (aldehyde modified) alginates yielded patches with improved burst pressure performance and decreased delamination as compared with pure AMA. Human mesothelial cell (MeT-5A) viability and cytotoxicity were retained when cultured with the hydrogel patches. The release and bioactivity of doxorubicin-encapsulated submicrospheres enabled the fabrication of drug-eluting adhesive patches and were effective in decreasing human lung cancer cell (A549) viability.
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Affiliation(s)
- Spencer L. Fenn
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155
- Bioengineering Program, College of Engineering and Mathematical Sciences, and Larner College of Medicine, University of Vermont, Burlington, VT, 05405
| | - Patrick N. Charron
- Department of Mechanical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
| | - Rachael A. Oldinski
- Bioengineering Program, College of Engineering and Mathematical Sciences, and Larner College of Medicine, University of Vermont, Burlington, VT, 05405
- Department of Mechanical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
- Department of Electrical and Biomedical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, 05405
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Broska CA, Botelho AB, Linhares ADEC, DE-Oliveria MS, Veronese G, Naufel CR, Batista LC, Diogo MAK. Profile of thoracic trauma victims submitted to chest drainage. Rev Col Bras Cir 2017; 44:27-32. [PMID: 28489208 DOI: 10.1590/0100-69912017001005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/03/2016] [Indexed: 11/22/2022] Open
Abstract
Objective to describe and compare the variables involved in trauma victims undergoing thoracic drainage. Methods we conducted a retrospective, analytical, descriptive, cross-sectional study, with medical records of patients attended at the Trauma Service of the Curitiba Evangelical University Hospital between February 2011 and January 2014. Results there were 488 patients undergoing chest drainage, 84.7% men and 15.3% women, with an average age of 38.2 years. Attendances usually occurred at night, without predominance between open or closed mechanism, gender or age group. The majority of patients with thoracic trauma requiring drainage were diagnosed by anamnesis and physical examination (41.1%) and drained in the emergency room (80.8%). Most of the patients (66.2%) had another associated lesion, mostly some abdominal viscera. Complications were present in 16.6% (81 patients), most of them due to drainage positioning error (9.2%). The mean hospital stay was 15 days and drainage lasted for an average of 8.1 days, with no statistical difference between open and closed trauma. The clinical outcome was discharge in most cases. Conclusion the profile of patients with thoracic trauma is that of young men, attended at night, with some other associated lesion. Although diagnosis and treatment were rapid and most often without the need for complex examinations, the time of drainage, hospitalization and complications were higher than in the literature, which can be explained by the drainage being made at the Emergency Room and the presence of associated injuries.
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Affiliation(s)
- Cesar Augusto Broska
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Adriane Barbosa Botelho
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - André DE Castro Linhares
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Mariana Santos DE-Oliveria
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Gabriela Veronese
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Carlos Roberto Naufel
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Lislaine Cruz Batista
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
| | - Maria Angélica Kurpel Diogo
- - Curitiba Evangelical University Hospital, General Surgery and Trauma Service, Curitiba, Parana State, Brazil
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Abstract
Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.
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