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Quinn J, Panasenko SI, Leshchenko Y, Gumeniuk K, Onderková A, Stewart D, Gimpelson AJ, Buriachyk M, Martinez M, Parnell TA, Brain L, Sciulli L, Holcomb JB. Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med 2024; 189:17-29. [PMID: 37647607 DOI: 10.1093/milmed/usad253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict. Graphical Abstract.
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Affiliation(s)
- John Quinn
- Prague Center for Global Health, Prague 120 00, Czech Republic
- East Surrey Emergency Department, Redhill RH1 5RH, UK
| | - Serhii I Panasenko
- Department of Surgery No 3, Poltava State Medical University, Poltava 36039, Ukraine
| | | | - Konstantyn Gumeniuk
- Ukrainian Armed Forces (UKR), Headquarters of Medical Forces of Military Forces, Kyiv 03168, Ukraine
| | - Anna Onderková
- Department of Oncology, Division of Surgery, University College London Hospital, London NW1 2BU, UK
| | - David Stewart
- Emergency & Deployed Medicine San Diego, California, USA
| | | | | | | | - Tracey A Parnell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leonid Brain
- NewYork-Presbyterian Brooklyn Methodist Hospital Emergency Department
| | - Luke Sciulli
- Auton Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - John B Holcomb
- Prague Center for Global Health, Prague 120 00, Czech Republic
- Emergency & Deployed Medicine San Diego, California, USA
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL
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Onderková A, Butler PEM, Kalavrezos N. The efficacy of negative-pressure wound therapy for head and neck wounds: A systematic review and update. Head Neck 2023; 45:3168-3179. [PMID: 37860929 DOI: 10.1002/hed.27547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/20/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under-explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty-one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post-reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.
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Affiliation(s)
- Anna Onderková
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
- Department of Head & Neck, University College London Hospitals (UCLH), London, UK
| | - Peter E M Butler
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Nicholas Kalavrezos
- Department of Head & Neck, University College London Hospitals (UCLH), London, UK
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Mahdian N, Onderková A, Brizman E, Pavlíková G, Vlachopulos V, Drahoš M, Foltán R. External fixation greatly improves outcomes in the surgical treatment of osteoradionecrosis of the jaws without affecting quality of life: a five-year retrospective study. Br J Oral Maxillofac Surg 2020; 58:e45-e50. [PMID: 32564971 DOI: 10.1016/j.bjoms.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Osteoradionecrosis of the jaw can be treated using both conservative treatment and surgery. External fixation may be used to bridge large resection defects after sequestrectomy for stabilisation and before secondary mandibular reconstruction. We designed a retrospective analysis of 70 patients with osteoradionecrosis treated between the years 2014 and 2018, and found that the use of external fixation greatly improves their outcomes. Patients were grouped according to Notani's classification: those who had Notani I disease were treated surgically but without external fixation; and those with Notani II and Notani III disease were eligible for external fixation. In those with Notani II disease, there was a significant reduction in the number of pathological fractures that occurred with external fixation. In those with Notani III disease, the success rate of primary sequestrectomy was only 1:14; however, those treated with external fixation all successfully healed after their first operation. It was hypothesised that although external fixation would improve outcome, it would come at a detriment to their quality of life (QoL). However, in a subset of these patients, we showed that in addition to increasing successful healing, patients' QoL with the external fixator was no worse than when they had an active osteonecrotic lesion. The treatment of osteoradionecrosis is cumbersome and advanced stages are associated with more complications. The use of an external fixator significantly reduces the probability of pathological fractures and increases the rate of successful healing in patients after mandibular resection. It does this without greatly interfering with patients' lives, while improving their condition sufficiently to allow for subsequent mandibular reconstruction.
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Affiliation(s)
- Nima Mahdian
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
| | - Anna Onderková
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic.
| | - Eitan Brizman
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
| | - Gabriela Pavlíková
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
| | - Vasilis Vlachopulos
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
| | - Milan Drahoš
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
| | - René Foltán
- Department of Oral & Maxillofacial Surgery, First Faculty of Medicine, Charles University and the General University Hospital, Prague, Czech Republic
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Csanády A, Onderková A. Morphological variation and allometry of the baculum in stoats, Mustela erminea (Carnivora, Mustelidae) from Western Carpathians. ACTA ZOOL ACAD SCI H 2018. [DOI: 10.17109/azh.64.1.103.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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