Treatment Of Severe Trauma Research Articles

Open abdomen and temporary abdominal closure techniques with negative pressure

Introduction Nowadays, the open abdomen is widely accepted method for а treatment of severe trauma, severe diffuse peritonitis and abdominal compartment syndrome. During the past 30 years numerous techniques for temporary abdominal closure have been described. The aim of the present study is to review the literature and to compare the effectiveness of the techniques with negative pressure – vacuum pack (VP) and Vacuum Assisted Closure (V.A.C., KCI), which have received a vast popularity in the last two decades. Material and methods The literature search was performed in PUBMED for the period 1995-2014 with key words – “open abdomen”, “temporary abdominal closure”, “VP”, “V.A.C.”. For the purpose of the review, only original articles with a clear description of the methodology and results were considered. Results For the period 2002-2014, 17 eligible studies evaluating the outcome in V.A.C. only and were found with overall 1146 patients and 8 studies reporting V.A.C. with dynamic fascial closure with 413 patients. For the same period, 12 studies evaluating effectiveness of VP only with 921 patients and 4 VP with dynamic fascial closure with 218 patients were found. There were only 2 studies directly comparing VP and V.A.C. Conclusions The literature review demonstrates higher rate of primary fascial closure and lower mortality rate in V.A.C. in comparison to VP on the background of similar frequency of EAFs and intraabdominal abscesses. Based on the results and on our own experience the use of dynamic fascial closure in addition to V.A.C. facilitates the primary fascial closure and should be used in all cases with expected duration of the OA over 9 days. Due to the possible complications the wanton use of the open abdomen should be avoided and all efforts for early closure should be made in the course of the treatment.

Clinical analysis of vitrectomy for 20 cases of severe ocular trauma with no light perception

Objective To evaluate the clinical efficacy of vitrectomy for treatment of severe ocular trauma with no light perception. Methods 20 eyes of 20 cases of severe ocular trauma with no light perception who underwent vitrectomy in our hospital from January 2005 to October 2013 were retrospectively ana- lyzed. Postoperative follow-up was 3 months to 2 years. Results No light perception was in 6 cases and the vision was recovered to light perception to 0.12 in 14 eyes. The retinas were attached in all patients when they were discharged from the hospital. Recurrent retinal detachment happened in 2 cases after gas absorption and silicon oil was injected again. After half a year retinal detached again in 3 eyes after removal of silicon oil and silicone oil was reinjected in 2 eyes. 1 case refused reoperation for eye and received evisceration and artificial orbital implantation because of eyeball atrophy. Conclusion Eyes of severe ocular trauma with no light perception have poor prognosis,then vitrectomy can maintain the eye appearance, and restore vision to some extent. Key words: Viterctomy; Trauma, ocular,severe; Perception, light,no

Squalenoyl adenosine nanoparticles provide neuroprotection after stroke and spinal cord injury.

There is an urgent need to develop new therapeutic approaches for the treatment of severe neurological trauma, such as stroke and spinal cord injuries. However, many drugs with potential neuropharmacological activity, like adenosine, are inefficient upon systemic administration because of their fast metabolisation and rapid clearance from the bloodstream. Here, we show that the conjugation of adenosine to the lipid squalene and the subsequent formation of nanoassemblies allow a prolonged circulation of this nucleoside, to provide neuroprotection in mouse stroke and rat spinal cord injury models. The animals receiving systemic administration of squalenoyl adenosine nanoassemblies showed a significant improvement of their neurologic deficit score in the case of cerebral ischaemia, and an early motor recovery of the hindlimbs in the case of spinal cord injury. Moreover, in vitro and in vivo studies demonstrated that the nanoassemblies were able to extend adenosine circulation and its interaction with the neurovascular unit. This paper shows, for the first time, that a hydrophilic and rapidly metabolised molecule like adenosine may become pharmacologically efficient owing to a single conjugation with the lipid squalene.

Non-operative versus operative treatment for blunt pancreatic trauma in children.

Pancreatic trauma in children is a serious condition with high morbidity. Blunt traumatic pancreatic lesions in children can be treated non-operatively or operatively. For less severe, grade I and II, blunt pancreatic trauma a non-operative or conservative approach is usually employed. Currently, the optimal treatment, of whether to perform operative or non-operative treatment of severe, grade III to V, blunt pancreatic injury in children is unclear. To assess the benefits and harms of operative versus non-operative treatment of blunt pancreatic trauma in children. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (Issue 5, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED and CPCI-S) and ZETOC. In addition, we searched bibliographies of relevant articles, conference proceeding abstracts and clinical trials registries. We conducted the search on the 21 June 2013. We planned to select all randomised clinical trials investigating non-operative versus operative treatment of blunt pancreatic trauma in children, irrespective of blinding, publication status or language of publication. We used relevant search strategies to obtain the titles and abstracts of studies that were relevant for the review. Two review authors independently assessed trial eligibility. The search found 83 relevant references. We excluded all of the references and found no randomised clinical trials investigating treatment of blunt pancreatic trauma in children. This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials. We recommend that multi-centre trials evaluating non-operative versus operative treatment of paediatric pancreatic trauma are conducted to establish firm evidence in this field of medicine.

The development and validation of the Readiness to Engage in Self-Management after Acute Traumatic Injury Questionnaire.

Although the management of acute traumatic injury has improved, long-term functional outcomes remain poor. Data suggest major improvements in outcome will require comprehensive, self-management (SM) interventions. However, little is known about trauma survivors' willingness to participate in such interventions. The goal of this study was to create and validate an instrument based on the stages of change (SOC) framework to assess readiness to engage in SM programs following acute traumatic injury. The Readiness to Engage in Self-Management after Acute Traumatic Injury (RESMATI) was developed based on SOC theory. Participants (N = 150) were admitted to a Level I trauma center for treatment of severe trauma and completed the RESMATI 3 to 12 months postinjury. A random sample (n = 60) completed a reassessment 1 month later to determine item stability. A principal components analysis and an exploratory factor analysis were conducted. The analyses of the 34 RESMATI items yielded a 5-factor model, collapsed into 3 domains based on SOC theory. Two factors were classified as "precontemplation," 2 factors were classified as "contemplation," and 1 factor was classified as "action/maintenance." All 3 domains had good internal consistency reliability (.71 to .92) and moderate test-retest reliability (.56 and .73). The exploratory factor analysis yielded 3 domains that were consistent with the SOC model. Two notable exceptions were the lack of a "preparation" domain and lack of distinction between the action and maintenance stages. The RESMATI is a reliable instrument that requires further testing to establish validity and utility in identifying individuals' readiness to engage in SM following acute traumatic injury.

Über Versorgungsstrukturen und Möglichkeiten der Optimierung durch Vernetzung bei schweren Handverletzungen und Replantationen

Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand Surgery (DGH). This article comprises 2 parts. First, the state-of-the-art of acute severe hand trauma care is summarised and explained. Subsequently, the above-mentioned pilot project is described in every detail, including positive effects but also barriers that still have to be overcome.

Role of intensive care unit in treatment of severe multiple trauma

Objective To investigate the criteria and significance for management of severe multiple trauma in the intensive care unit (ICU).Methods Data of 64 patients with non-fatal severe multi-trauma (ISS≥20) treated in the First Aid Center for Traffic Injuries in 117th Hospital of PLA between 2006-2012 documented in China Trauma Database were analyzed.Differences in trauma scoring,complications,functional prognosis and medical cost were analyzed between ICU and non-ICU patients.Results There were statistical differences for GCS and revised trauma score (RTS) between ICU patients and non-ICU patients (P ＜ 0.05),but the differences were insignificant for ISS and new ISS (NISS).Likewise,the differences were significant for complication incidence and functional independence measure (FIM) on discharge (P ＜ 0.05),but not in the length of hospital stay and medical cost.Complication incidence of non-ICU patients was 2.96 times that of ICU patients.FIM of ICU patients scored 10.11 ± 2.10,far higher than that of non-ICU patients (P ＜ 0.05).Conclusion For severe multiple trauma patients with ISS≥20,the admission to the ICU is helpful for reduction of the complication rate. Key words: Multiple trauma; Database; Intensive care unit

The clinical efficacy and prognosis of hemisphere skull bone flap decompression and mild hypothermia treatment for severe craniocerebral trauma

In this study, 1626 patients with severe craniocerebral trauma were assessed by Glasgow Coma Scale (GCS, 886 patients of 3-5 score and 740 of 6-8 score). Patients were divided into 2 groups. Ninety hundred and eleven patients (496 of 3-5 score and 415 of 6-8 score) underwent hemisphere calvarial bone flap decompression with auxiliary mild hypothermia (experiment group), and 715 patients (390 of 3-5 score and 325 of 6-8 score) underwent traditional frontal, temporal, parietal large traumatic craniotomy (control group). After operation the treatment of 2 groups was basically the same. Compared with control group, the intracranial pressure of experiment group on the 1st, 3rd, 5th and 7th days after surgery decreased significantly (P < 0.05, for all); the consciousness recovery time was significantly shorter (P < 0.05, for all); the prognosis after 3 months was better (P < 0.05, for all). Hemisphere calvarial bone flap decompression with auxiliary mild hypothermia treatment could significantly reduce the morbidity and mortality, and improve the quality of life and prognosis of patients with severe craniocerebral trauma.

중증외상특성화센터의 공간구성 및 면적구성에 관한 연구 - 권역응급의료센터를 중심으로

Purpose: As emergency medical service fund is further expanded due to amendment of the law on emergency medical services in 2008, Korean government has prepared to intervene in a comprehensive manner to strengthen a trauma treatment system. As a result, it announced a master plan to establish a serious trauma treatment center in 16 areas across the nation. Therefore, this study has attempted to investigate the current status of the serious trauma treatment centers and suggest the goal and improvement plan of future serious trauma treatment centers. Methods: As of 2011, Korea operates 23 emergency cerebrovascular service centers, 23 emergency heart disease centers and 35 severe trauma treatment centers across the country. 12 emergency medical service centers have been chosen among the serious trauma treatment centers. Then, top six (6) centers chosen at Emergency Medical Institute Assessment 2011 by Ministry of Health and Welfare have been selected, and floor layout and spatial allocation by usage have been reviewed and analyzed. Results: Consequently, this study has investigated the spatial components, circulation layout and spatial allocation of a serious trauma treatment. For construction planning in consideration of the fundamental objectives and goal of emergency medical services, it is essential to allot spaces and select exact spatial components. It appears that it is necessary to design spaces for emergency medical services and come up with construction planning through appropriate spatial allocation.

Observation on the efficacy of the vitreous operation in treatment of severe ocular trauma

Objective To evaluate the clinical effects of vitreous operation in treatment of severe ocular trauma.Methods From January 2009 to December 2010 in our hospital 58 cases with severe ocular trauma (58 eyes),all took vitreous operation treatment,and were observed the effects of the treatment,complications and compared the visual acuity before and after treatment.Results After the treatment,among 58 eyes,function of 35 eyes were cured (60.3％),the anatomy of 18 eyes were cured (31.0％),treatment failure in 5 eyes (8.7％),the total effective rate was 91.4％.Conclusions Vitreous operation in treatment of severe ocular trauma has excellent clinical effect,can effectively improve and restore vision,also keep the eye anatomy. Key words: Vitreous operation; Severe ocular trauma; Complication; Visual acuity

Successful treatment of severe penetrating cranio-cerebral trauma, associated with brain compression

Introduction. Surgical treatment of severe penetrating cranio-cerebral trauma (SCCT) is a complex problem. Basal liquorrhea (BL) at skull base fractures causes high risk of purulent-septic complications. Conservative BL treatment at scull base fractures with many splinters sometimes ineffective. Along with intracranial hypertensia elimination at decompressive craniectomy (DC) performance and mass-centers removing, during primary operation plastics of scull base defects is needed.Methods. In two patients with SCCT during one operation DC and mass-centers removing were performed stage-by-stage, plastics of scull base defects, using autotissue on a feeding stalk and haemostatic sponge with fibrin-trombin covering “Takhokomb” were used. For intracranial hypertension control during operation and after it continuous monitoring of intracranial pressure was used.Results. The use of proposed approach to SCCT treatment allowed to provide control of intracranial pressure after operation and liquorrhea termination, to avoid intracranial purulent-septic complications.Conclusions. Stage-by-stage DC, mass-centers removing and removal and skull base defects plastics during primary operation — is an effective method of surgical treatment of SCCT, combined with brain compression, scull base fractures and profuse nasal liquorrhea.

First aid and nursing experience on 116 cases of severe multiple trauma

[Objective]To explore the effectiveness of early and positive first aid and nursing measures on patients with severe multiple trauma to see the possibility of increasing cure rate and reducing the motality.[Methods] A retrospective analysis was carried out to summarize the clinical data of 116 cases of severe multiple traumatic in our hospital from January 2008 to December 2011,and we analyzed the main points of aid for severe multiple trauma treatment.[Results]Among the 116 patients with severe multiple trauma,103(89.8％) were rescued successfully,only 13 dead.[Conclusion]Severe multiple traumas usually involve multiple organs,which is critical,complicated and change quickly,so,improper treatment could make it worse,even death.In order to take proper first aid measures and careful nursing,it's important for nurses to strengthen first aid consciousness,and be able to make accurate evaluation on trauma,timely and overall assessment. Key words: Severe multiple trauma; Trauma; First aid; Nursing

A report of pupilloplasty for secondary glaucoma after vitrectomy associated with ocular trauma.

Blunt ocular trauma is frequently seen in clinical practice, and is likely to cause ocular structure disrupture and visual function impairment. Vitrectomy is considered as an efficacious treatment of severe ocular trauma; however, secondary glaucoma has been frequently observed postoperatively.The present paper reported a case undergoing pupilloplasty, which successfully lowered intraocular pressure (IOP), reconstructed anterior segment structure, and restored visual function.

Prinzipien und Möglichkeiten der Defektedeckung im distalen Unterschenkeldrittel und Sprunggelenkbereich

The lower leg is the most often severely injured part of the lower extremity. Despite improved operative techniques, soft tissue defects alone or in combination with bone defects that cannot be closed by secondary suture still present a complex diagnostic and therapeutic problem. Modern treatment of severe trauma to the distal lower leg requires a global defect management which is based on: 1) profound basic knowledge, 2) multidisciplinary treatment team using a “common language” concerning diagnosis, classification and treatment, and 4) an integrated treatment concept. Adequate primary defect reconstruction is the basis of any successful treatment. For function improvement a variety of secondary operations like muscle/tendon transfer, tenodesis, capsulodesis, arthrodesis or ultimatively free functional muscle transplantation alone or in combination are available. Moreover adjuvant procedures such as orthesis, orthopaedic shoes, etc. may be useful at any time of treatment.

Successful treatment of penetrable severe cranio-cerebral trauma

Successful treatment of penetrable severe cranio-cerebral trauma

Clinical application of damage control surgery in treatment of severe liver trauma

：Objective To discuss theclinical application of damage control (DC)in the treatment of severe liver trauma.Methods A retrospective study was done to analyze the clinical data of 28patients withsevere liver trauma ( Ⅲ-Ⅵ degree)who had the complications of hemodynamic instability,hypothermia, metabolic acidosis andblood coagulation disturbance and were treated with DC from April 2003 to April 2010 tosum up the operation indication, complications and mortality rate of DC. Results Of allthe patients, 16 patients were cured and four died, with cure rate of 80% and mortalityrate of 20%. Ten patients (50%) had complications after operation. Conclusions For thepatients with severe liver trauma, DC is a safe and reliable operation method and caneffectively lower complications and mortality rate when there appear hemodynamicinstability, hypothermia, metabolic acidosis and blood coagulation disturbancecomplications. Key words: Multiple trauma; Liver; Damage control

Multidisciplinary team mode in emergency treatment of severe trauma

严重创伤是威胁人类健康的元凶之一,9·11恐怖袭击、5·12汶川地震等更加凸显了这一严峻挑战.如同灾害医学救援,严重创伤急救最主要的不是发展新的技术,而是形成高效的组织模式.

Orbital Augmentation With Injectable Calcium Hydroxylapatite for Correction of Postenucleation/Evisceration Socket Syndrome

To demonstrate the utility of injectable calcium hydroxylapatite (Radiesse) for orbital volume augmentation to correct postenucleation/evisceration socket syndrome (PESS). A retrospective chart review of all consecutive patients in our practice who received injectable calcium hydroxylapatite placed in the extraconal space to augment orbital volume was conducted. Patients with at least 6 months follow-up were included in the study. Among 26 patients with PESS who received injectable calcium hydroxylapatite for orbital volume augmentation, 15 individuals were identified with adequate follow-up. The mean amount of preoperative relative enophthalmos measured by Hertel exophthalmometry was 4 mm (range 0.5-7 mm). An average reduction of 2.4 mm of enophthalmos per syringe of filler was achieved. The mean follow-up obtained was 46 weeks (range 24-78 weeks). Most patients demonstrated clinical and aesthetic improvement that was observed to continue up to 1.5 years. Complications observed included anterior migration of filler, a peribulbar hemorrhage, and orbital discomfort. Two patients demonstrated little response to filler. Injectable calcium hydroxylapatite provides a novel, safe, simple, cost-effective technique to treat volume deficiency in the anophthalmic orbit. Augmentation achieved with this semipermanent filler has demonstrated a lasting effect in the orbit with little volume loss. Volume replacement can be titrated to the socket requirements. Correction of PESS using this technique may be limited in orbits that demonstrate significant fibrosis as a result of multiple surgeries, severe trauma, or radiation treatment.

Osteomyoplastic transtibial amputation: technique and tips

Treatment of severe lower extremity trauma, diabetic complications, infections, dysvascular limbs, neoplasia, developmental pathology, or other conditions often involves amputation of the involved extremity. However, techniques of lower extremity amputation have largely remained stagnant over decades.This article reports a reproducible technique for transtibial osteomyoplastic amputation.

The Evolution of Elbow Arthroplasty: Innovative Solutions to Complex Clinical Problems

Cross, Michael B. MD1; Sherman, Seth L. MD1; Kepler, Christopher K. MD, MBA1; Neviaser, Andrew S. MD1; Weiland, Andrew J. MD1 Author Information