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Treffalls RN, Stonko DP, DeMartino RR, Morrison JJ. Acute management of mesenteric emergencies: Tailoring the solution to the problem. Semin Vasc Surg 2023; 36:234-249. [PMID: 37330237 DOI: 10.1053/j.semvascsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
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Affiliation(s)
- Rebecca N Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - David P Stonko
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan J Morrison
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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2
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García A, Millán M, Burbano D, Ordoñez CA, Parra MW, González Hadad A, Herrera MA, Pino LF, Rodríguez-Holguín F, Salcedo A, Franco MJ, Ferrada R, Puyana JC. Damage control in abdominal vascular trauma. Colomb Med (Cali) 2022; 52:e4064808. [PMID: 35027780 PMCID: PMC8754163 DOI: 10.25100/cm.v52i2.4808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
In patients with abdominal trauma who require laparotomy, up to a quarter or a third will have a vascular injury. The venous structures mainly injured are the vena cava (29%) and the iliac veins (20%), and arterial vessels are the iliac arteries (16%) and the aorta (14%). The initial approach is performed following the ATLS principles. This manuscript aims to present the surgical approach to abdominal vascular trauma following damage control principles. The priority in a trauma laparotomy is bleeding control. Hemorrhages of intraperitoneal origin are controlled by applying pressure, clamping, packing, and retroperitoneal with selective pressure. After the temporary bleeding control is achieved, the compromised vascular structure must be identified, according to the location of the hematomas. The management of all lesions should be oriented towards the expeditious conclusion of the laparotomy, focusing efforts on the bleeding control and contamination, with a postponement of the definitive management. Their management of vascular injuries includes ligation, transient bypass, and packing of selected low-pressure vessels and bleeding surfaces. Subsequently, the unconventional closure of the abdominal cavity should be performed, preferably with negative pressure systems, to reoperate once the hemodynamic alterations and coagulopathy have been corrected to carry out the definitive management.
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Affiliation(s)
- Alberto García
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia Fundación Valle del Lili Department of Surgery Division of Transplant Surgery Cali Colombia
| | - Daniela Burbano
- Universidad de Caldas, Departamento de Cirugía. Manizales, Colombia. Universidad de Caldas Universidad de Caldas Departamento de Cirugía Manizales Colombia
| | - Carlos A Ordoñez
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA Broward General Level I Trauma Center Department of Trauma Critical Care Fort LauderdaleFL USA
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Centro Médico Imbanaco, Cali, Colombia. Centro Médico Imbanaco Cali Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Universidad Icesi, Cali, Colombia. Universidad Icesi Universidad Icesi Cali Colombia.,Hospital Universitario del Valle, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Hospital Universitario del Valle Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - María Josefa Franco
- Fundación Valle del Lili. Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery Cali Colombia
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia. Universidad del Valle Universidad del Valle Facultad de Salud Escuela de Medicina Cali Colombia.,Centro Médico Imbanaco, Cali, Colombia. Centro Médico Imbanaco Cali Colombia
| | - Juan Carlos Puyana
- University of Pittsburgh. Critical Care Medicine. Pittsburgh, PA, USA. University of Pittsburgh University of Pittsburgh Critical Care Medicine PittsburghPA USA
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3
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Tao F, Zhonghu L, Xun C, Jianxin Z, Yanbing S, Weidong J. Damage Control Surgery for Severe Abdominal Sepsis With Free Skin Graft Transplantation: A Case Report. Transplant Proc 2022; 54:185-188. [PMID: 35016778 DOI: 10.1016/j.transproceed.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute abdomen represents a great surgical challenge. Damage control surgery has been a better approach in acute abdominal emergencies to reduce the risk of mortality compared with primary definitive surgery. CASE PRESENTATION A 52-year-old man presented with nonspecific abdominal pain for 2 days. Physical examination and computed tomography scan suggested abdominal viscera perforation and acute diffuse peritonitis. Segmental resections and sigmoidostomy were performed, the abdomen was temporarily closed with a 3-liter infusion bag and maintained for 72 hours. Small intestinal ischemic necrosis was found, partial resection of small intestine was performed later, and abdomen was still closed with the 3-liter infusion bag and maintained for 10 days. One month later, intermediate split thickness self-free skin graft transplantation was performed. Abdomen was closed 6 months later. CONCLUSIONS Damage control surgery with free skin graft transplantation can be successfully applied in severe abdominal infection in patients with an open abdomen. The study was in compliance with the Helsinki Congress and the Declaration of Istanbul. CORE TIP Damage control surgery has been a better approach in acute abdominal emergencies to reduce the risk of mortality compared with definitive surgery. Although laparostomy is a useful treatment of abdominal sepsis, successful management with free skin graft transplantation after laparostomy has rarely been reported in stercoral perforation. We report a patient with severe abdominal sepsis treated with damage control surgery with free skin graft transplantation. The patient was discharged with good recovery.
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Affiliation(s)
- Fu Tao
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China
| | - Li Zhonghu
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China
| | - Cai Xun
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China
| | - Zhang Jianxin
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China
| | - Shen Yanbing
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China
| | - Jin Weidong
- Department of General Surgery, Central Theater Command General Hospital of PLA, Wuhan, China.
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Milne DM, Rambhajan A, Ramsingh J, Cawich SO, Naraynsingh V. Managing the Open Abdomen in Damage Control Surgery: Should Skin-Only Closure be Abandoned? Cureus 2021; 13:e15489. [PMID: 34268021 PMCID: PMC8261903 DOI: 10.7759/cureus.15489] [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: 06/07/2021] [Indexed: 11/05/2022] Open
Abstract
During damage control laparotomy, surgery is abbreviated to allow for the correction of physiologic disturbances, with a plan to return to the operating theatre for definitive surgical repair. Re-entry into the abdomen is facilitated by temporary abdominal closure (TAC). Skin-only closure is one of the many techniques described for TAC Numerous sources advise against the use of this technique because of the risk of complications. This case report describes the use of skin-only closure during a damage control laparotomy. We reviewed the literature surrounding the various options for TAC to elucidate the potential role of skin-only closure after damage control laparotomy.
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Affiliation(s)
- David M Milne
- General Surgery, General Hospital Port of Spain, Port of Spain, TTO
| | - Amrit Rambhajan
- General Surgery, General Hospital Port of Spain, Port of Spain, TTO
| | - Jason Ramsingh
- General Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, GBR
| | - Shamir O Cawich
- Surgery, The University of the West Indies, St. Augustine, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.,Surgery, Medical Associates Hospital, St. Joseph, TTO
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Figueroa-Gutiérrez L, Martínez-Cano J, Giraldo-Ossa B, López-González LA, Echeverry-Rendón S, Rodríguez-Suárez E, Galvis-Acevedo S, Flórez-López JA. Terapia de presión negativa en pediatría. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La terapia de presión negativa es un recurso utilizado cada vez con mayor frecuencia en el manejo de heridas complejas en pediatría. El objetivo de este estudio fue describir la experiencia con esta terapia en diferentes situaciones clínicas.
Métodos. Se llevó a cabo un estudio descriptivo retrospectivo en un grupo de pacientes pediátricos en quienes se utilizó la terapia de presión negativa entre el año 2010 y el 2015. Se analizaron las variables sociodemográficas, los diagnósticos que indicaron la terapia, el tiempo de uso, sus complicaciones y la mortalidad.
Resultados. Se incluyeron 41 pacientes. La terapia se indicó en 39 casos con heridas localizadas en el abdomen, en uno con infección de los tejidos blandos perianales y en otro con una herida de esternotomía infectada. De las heridas abdominales, 14 fueron por complicaciones relacionadas con apendicitis aguda, 6 por enfermedades relacionadas con megacolon, 5 por obstrucción intestinal, 4 para el manejo de fístulas, 4 por enterocolitis necrosante del recién nacido, 3 por pancreatitis aguda y 3 por otras causas. El tiempo promedio de uso de la terapia fue de 7 días. Se presentaron fallas en el sistema de vacío en dos pacientes, pero no hubo complicaciones por el uso de la terapia. Dos pacientes fallecieron por complicaciones relacionadas con su enfermedad de base.
Conclusión. La terapia de presión negativa es un recurso efectivo en el manejo de heridas complejas en la población pediátrica.
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Calis H, Sengul S, Guler Y, Karabulut Z. Non-healing wounds: Can it take different diagnosis? Int Wound J 2019; 17:443-448. [PMID: 31884720 DOI: 10.1111/iwj.13292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023] Open
Abstract
Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.
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Affiliation(s)
- Hasan Calis
- Department of General Surgery, Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey
| | - Serkan Sengul
- Department of General Surgery, Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey
| | - Yilmaz Guler
- Department of General Surgery, Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey
| | - Zulfikar Karabulut
- Department of General Surgery, Alanya Alaaddin Keykubat University Training and Research Hospital, Alanya, Turkey
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Faulconer ER, Davidson AJ, Bowley D, Galante J. Negative pressure temporary abdominal closure without continuous suction: a solution for damage control surgery in austere and far-forward settings. J ROY ARMY MED CORPS 2018; 165:163-165. [PMID: 30181381 DOI: 10.1136/jramc-2018-000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/04/2022]
Abstract
The use of topical negative pressure dressings in temporary abdominal closure has been readily adopted worldwide; however, a method of continuous suction is typically required to provide a seal. We describe a method of temporary abdominal closure using readily available materials in the forward surgical environment which does not require continuous suction after application. This method of temporary abdominal closure provides the benefits of negative pressure temporary abdominal closure after damage control surgery without the need for continuous suction or specialised equipment. Its application in damage control surgery in austere or far-forward settings is suggested. The technique has potential applications for military surgeons as well as in humanitarian settings where the logistic supply chain may be fragile.
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Affiliation(s)
| | - A J Davidson
- Department of Trauma Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - D Bowley
- 16 Medical Regiment, Colchester, UK
| | - J Galante
- Department of Trauma Surgery, University of California Davis Medical Center, Sacramento, California, USA
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