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1.
Penetrating Cardiac Injuries: A Complex Challenge 总被引:2,自引:0,他引:2
Asensio JA Soto SN Forno W Roldán G Petrone P Gambaro E Salim A Rowe V Demetriades D 《Surgery today》2001,31(12):1041-1053
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Penetrating vascular trauma in Johannesburg, South Africa 总被引:3,自引:0,他引:3
An awareness that time crucially affects outcome underpins the principles of management of vascular injury. Patients with hard signs of vascular injury should undergo urgent exploration. Soft signs mandate investigation, and arteriography is still the standard of care. Noninvasive vascular imaging may prove its worth in the future. All patients with penetrating arterial injury should receive broad-spectrum antibiotic prophylaxis. Early repair of carotid artery injury provides the best likelihood of a neurologically intact survivor. There is a definite and emerging role of endovascular therapy both for difficult access injuries and for the later complications of vascular injury, such as false aneurysm and arteriovenous fistulas. The experimental and clinical evidence for the use of intraluminal shunts in peripheral vascular injury is compelling, and experience in their use is accumulating. Vascular trauma is complex and ideally is carried out by experts in a multidisciplinary environment; resuscitation and prompt revascularization are likely to lead to satisfactory outcomes. The major trauma load in South Africa represents an unparalleled experience in management of vascular injury, which seems likely to continue for the foreseeable future. 相似文献
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B. Raj Siddharth M. S. S. Keerthi Subrahmaneswara Babu Naidu M. Venkanna 《The Indian journal of surgery》2017,79(3):196-200
Penetrating abdominal trauma forms an important component of surgical emergencies, most of the victims being young aged in the prime of their life. Over the past century, the diagnosis and management of this common problem has seen drastic changes, finally reaching the destination of selective approach. We present our experience in the management of this group of patients in the rural setup. This is a prospective observational study done at our hospital between 1 April 2013 and 31 March 2015 including patients who presented with penetrating abdominal injury. The clinical presentation, imaging features, diagnosis, management, and complications of all these patients are analyzed. The mean age was 33.5 years with majority being males. Homicidal stab injuries accounted for most of the injuries (62.5 %). Forty-eight patients underwent laparotomy, and among which, the procedure was therapeutic in 36 patients. Peritoneal penetration was the best predictor of a therapeutic laparotomy with a high sensitivity and positive predictive value (100 and 80 %, respectively). The small intestine was the most commonly injured organ. The mean postoperative stay was 8.25 days, and there was no mortality. Though the management of these patients should aim at minimizing the rate of negative laparotomies, this should not be done at the expense of delayed diagnosis and treatment. Diagnostic laparoscopy may avoid unnecessary laparotomies; however, it requires adequate skills in laparoendoscopy. Management is best tailor made for each individual based on the nature of injury, findings at presentation, and the organ injured. 相似文献
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A Ramasamy SE Harrisson MPM Stewart M Midwinter 《Annals of the Royal College of Surgeons of England》2009,91(7):551-558
INTRODUCTION
Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict.PATIENTS AND METHODS
Data were prospectively collected on 100 consecutive patients either injured or killed from hostile action from January 2006 who presented to the sole coalition field hospital in southern Iraq.RESULTS
Eighty-two casualties presented with penetrating missile injuries from hostile action. Three subsequently died of wounds (3.7%). Forty-six (56.1%) casualties had their initial surgery performed by British military surgeons. Twenty casualties (24.4%) sustained gunshot wounds, 62 (75.6%) suffered injuries from fragmentation weapons. These 82 casualties were injured in 55 incidents (mean, 1.49 casualties; range 1–6 casualties) and sustained a total 236 wounds (mean, 2.88 wounds) affecting a mean 2.4 body regions per patient. Improvised explosive devices were responsible for a mean 2.31 casualties (range, 1–4 casualties) per incident.CONCLUSIONS
The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons. 相似文献7.
《The Surgical clinics of North America》2017,97(5):1065-1076
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Penetrating Cardiac Wounds: Principles for Surgical Management 总被引:8,自引:0,他引:8
Stab wounds are the main type of penetrating cardiac injury in China and they have a fairly good prognosis when the patient receives expeditious and appropriate management. The objective of this study is to present the experience of managing the patients with penetrating cardiac injuries. A retrospective study involving 82 cases with penetrating wounds of the heart in the past 16 years was carried out. Stab wounds accounted for 86.58% of this series (71 of 82 patients). All 82 cases were treated operatively. The amount of preoperative infusion as fluid resuscitation for shock was less than 1,000 ml in 65.85% of the present study. Only in three patients was preoperative pericardiocentesis performed, yielding a false-negative result in one. Six patients sustaining cardiac arrest soon after arrival were subjected to emergency room thoracotomy (ERT), and five of them surviced. The overall survival rate was 96.34%. One patient died of exsanguination due to injury of multiple chambers; of the remaining 2 deaths after operation 1 was associated with abdominal injuries and the other with failure of cerebral resuscitation. From the experience reported in this study, early establishment of diagnosis and prompt thoracotomy against time are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated. 相似文献
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Eddy H. Carrillo Brett J. Guinn Ahsan T. Ali Phillip W. Boaz David A. Spain J. David Richardson 《European Journal of Trauma》2000,26(3):116-121
Surgeon-performed ultrasound continues to evolve as a useful, safe, and efficient diagnostic alternative to document the presence of hemopericardium in patients sustaining penetrating injuries to the precordial region. With growing experience, its excellent sensitivity and specificity in the identification of cardiac injuries have become evident. As ultrasound for blunt abdominal trauma has been able to eliminate unnecessary diagnostic peritoneal lavages, its use in the evaluation of penetrating precordial injuries holds the promise to expedite the diagnosis of cardiac injuries and eliminate unnecessary pericardial windows and their associated morbidity. Ultrasound was performed by surgeons-in-training with supervision by a trauma surgeon at a Level-I trauma center in patients sustaining penetrating injuries to the precordial area. During the review period, 34 patients underwent precordial ultrasound (22 negative, 9 positive and 3 equivocal). There were no false-positives or false-negatives. All equivocal results were followed by a subxiphoid pericardial window that demonstrated no evidence of cardiac injury. Based o these data, we recommend that surgeon-performed ultrasound replace all other clinical, radiologic, and surgical diagnostic alternatives classically used to determine the presence of hemopericardium in stable patients with penetrating precordial injuries. Ultrasonography is fast, reliable, consistent, and easy to teach and learn. In those few patients with equivocal findings, other confirmatory diagnostics modalities should be entertained. 相似文献
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Background Selective nonoperative management (SNOM) of penetrating neck injuries (PNI) has steadily gained favor, but indications for
surgery and adjunctive diagnostic studies remain debated. The purpose of the present study is to validate a protocol of SNOM
of PNI based on physical examination, which further dictates complementary investigations and management.
Patients and methods A prospective observational study was conducted in a South African tertiary urban trauma center with a high prevalence of
penetrating trauma. All consecutive patients admitted with penetrating neck injuries over a 13-month period were included.
Results A total of 203 patients were included in the study: 159 with stab wounds and 42 with gunshot wounds. A vascular injury was
identified in 27 (13.3%) patients, pharyngoesophageal injury in 18 (8.9%) patients, and an upper airway injury in 8 (3.9%)
patients. Only 25 (12.3%) patients required surgical intervention. A further 8 (3.9%) patients had therapeutic endovascular
procedures. The remaining 158 (77.8%) patients, either asymptomatic or with negative work-up, were managed expectantly. There
were no clinically relevant missed injuries.
Conclusions Selective nonoperative management of neck injuries based on clinical examination and selective use of adjunctive investigational
studies is safe in a high-volume trauma center. 相似文献
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Salim A Teixeira PG Inaba K Brown C Browder T Demetriades D 《World journal of surgery》2008,32(3):471-475
Surgical site infections (SSIs), such as wound infection, fascial dehiscence, and intraabdominal abscess, commonly occur following
penetrating abdominal trauma. However, most of the literature involves penetrating colon injuries. There are few reports describing
complications following penetrating stomach and small bowel injuries. Based on the hypothesis that SSIs are commonly found
following penetrating stomach and small bowel trauma, a prospective observational study was performed at an academic Level
I trauma center from March 1, 2004 until August 31, 2006. The subjects were patients who had sustained a penetrating injury
to the stomach or small bowel. Patients were followed for the development of an SSI, defined as wound infection, fascial dehiscence,
or intraabdominal abscess. A total of 178 patients were admitted with penetrating stomach or small bowel injuries over the
29-month period. There were 121 (68%) gunshot injuries and 57 (32%) stab wounds. Associated intraabdominal injuries occurred
in 74% of patients. Overall, SSIs occurred in 20% of cases. Risk factors for SSI included associated duodenal or colon injury,
whereas time to operating room, blood loss, and type and duration of antibiotic use were not. When associated colon injuries
were excluded, SSIs occurred in 16% of patients with gastric injuries and 13% of those with small bowel injuries. SSIs commonly
follow penetrating stomach and small bowel trauma. Risk factors for SSI include associated duodenal or colon injury. Delay
to operating room, blood loss, and type and length of antibiotic prophylaxis were not associated with an increased risk of
SSI. 相似文献
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G. Öztürk B. Aydinli S. Selcuk Atamanalp F. Celebi M. Ilhan Yildirgan 《Acta chirurgica Belgica》2013,113(2):185-190
Objective: Penetrating colonic injuries are amongst the most discussed intra-abdominal injuries because of the complexity of their management and the severe complications. Penetrating colonic injuries can be managed by either primary repair or diversion. There is a debate over which procedure has to be used under which circumstances. In this retrospective study we analyzed our experience to contribute to the answer.Patients and methods: The records of patients with penetrating colonic injury between January 1995 and December 2006 at the General Surgery Department of Atatürk University School of Medicine, were reviewed retrospectively. Results: One hundred and forty-one patients were included in the study. Ten patients did not need any surgical treatment. Seventy-nine patients (56%) were treated without formation of a stoma and fifty-two patients (36.8%) with formation of a stoma. The overall complication rate was 50.3% (71 patients). The rate of septic complications was 33.3%.Conclusion: There is an ongoing debate whether formation of a stoma is indicated in penetrating colonic injury or not. Our clinical experience showed that severe faecal contamination, shock at presentation, and high CIS grades are associated with increased postoperative complications and mortality. Therefore the treatment of penetrating colonic injury in the presence of these risk factors should be stoma formation rather than primary repair. 相似文献
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Penetrating Chest Injuries: Unusually High Incidence of High-velocity Gunshot Wounds in Civilian Practice 总被引:1,自引:0,他引:1
Ilhan Inci Cemal Özçelik Ibrahim Taçyildiz Özgür Nizam Nesimi Eren Gökalp Özgen 《World journal of surgery》1998,22(5):438-442
n
= 190) followed by hemopneumothorax (
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= 184). Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the
patients. Thoracotomy was performed in 8.1%. The mean duration of hospitalization was 11.2 days. The mean injury severity
score (ISS) was 20.17 ± 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult
respiratory distress syndrome. Altogether 17% of patients with an ISS >25 died, whereas only 0.9% of those with a score <16
died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far
the most common method of treating penetrating injury to the chest. The easy availability of high-velocity guns will continue
to increase the number of civilians injured by these weapons. 相似文献
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Peep Talving MD PhD Joseph DuBose Galinos Barmparas Kenji Inaba Demetrios Demetriades 《European journal of trauma and emergency surgery》2009,35(3):225-239
Abstract
Terrorist violence has emerged as an increasingly common cause of mass casualty incidents (MCI) due to the sequelae of explosive
devices and shooting massacres. A proper emergency medical system disaster plan for dealing with an MCI is of paramount importance
to salvage lives. Because the number of casualties following a MCI is likely to exceed the medical resources of the receiving
health care facilities, patients must be appropriately sorted to establish treatment priorities. By necessity, clinical signs
are likely to prove cornerstones of triage during MCI. An appropriate and effective application of experiences learned from
the use of selective nonoperative management (SNOM) techniques may prove essential in this triage process. The present appraisal
of the available literature strongly supports that the appropriate utilization of these clinical indicators to identify patients
appropriate for SNOM is essential, critical, and readily applicable. We also review the initial emergent triage priorities
for penetrating injuries to the head, neck, torso, and extremities in a mass casualty setting. 相似文献
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电视胸腔镜在穿透性胸腹联合伤中的应用 总被引:1,自引:1,他引:1
目的探讨电视胸腔镜诊治穿透性胸腹联合伤的价值。方法全麻,双腔气管插管,胸腔镜探查损伤情况。损伤轻微者可行胸腔镜辅助胸壁小切口治疗。胸壁、胸膜腔出血行电凝止血、缝合止血、凝血块清除,多数膈肌裂伤可同时修补,出血、裂伤脏器可行修补或切除治疗。损伤严重者中转开胸、开腹探查。结果全组18例,电视胸腔镜辅助胸壁小切口完成胸部手术15例(膈肌修补15例,肋间动脉止血8例,肺修补2例,肺楔形切除2例,凝固性血胸清除2例),中转开胸3例(膈肌修补3例,心脏修补1例,食管修补1例,肺叶切除2例)。经胸行腹腔诊治13例(肝脏修补1例,脾脏切除1例,胃修补1例,膈疝还纳3例,探查7例),开腹诊治5例(胰腺修补1例,肝脏修补1例,脾脏切除1例,胃修补2例,大网膜及肠系膜修补3例)。1例多脏器穿透伤患者,虽经开胸、开腹治疗,但终因失血性休克、循环衰竭、DIC死亡。手术时间45~220min,(125±44)min;术中出血量500~10000ml,(1089±582)ml;术后24h胸腔引流量100~350ml,(234±75)ml;术后胸管留置时间2~5d,平均2.5d;术后排气时间1~4d,平均2d。12例门诊随访3~12个月,平均6个月,无与外伤相关的并发症发生。结论恰当地选择病例,电视胸腔镜辅助胸壁小切口诊治穿透性胸腹联合伤安全,疗效可靠。 相似文献