Temporary Intravascular Shunts: When Are We Really Using Them According to the NTDB?

2009 ◽  
Vol 75 (7) ◽  
pp. 605-607 ◽  
Author(s):  
Chad G. Ball ◽  
Andrew W. Kirkpatrick ◽  
Ravi R. Rajani ◽  
Amy D. Wyrzykowski ◽  
Christopher J. Dente ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Damage Control ◽  
Venous Blood ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Gunshot Wounds ◽  
Venous Blood Flow ◽  
Penetrating Injuries

Temporary intravascular shunts (TIVS) are synthetic intraluminal conduits that maintain arterial and/or venous blood flow. This technique can be used for: 1) replantation; 2) open extremity fractures with extensive soft tissue and arterial injuries; or 3) damage control (extremity/truncal). The literature defining TIVS is composed exclusively of small case series (primarily penetrating injuries). Our goal was to identify the injured population who actually undergoes TIVS using the National Trauma Data Bank (2001 to 2005). TIVS were placed in 395 patients (mean Injury Severity Score = 26; initial hemodynamic instability = 24%; mean based deficit = –7.2; mortality = 14%). Blunt mechanisms caused 64 per cent (251 of 395) of cases. Penetrating injuries were primarily gunshot wounds (97%). Concurrent severe extremity fractures and/or soft tissue defects were present in 185 (74%) blunt-injured patients. Only six of 111 centers performing TIVS used this technique five or more times. Only three centers used TIVS more than 10 times. The volume of TIVS use was similar across the study period ( P > 0.05). TIVS is primarily used in blunt motor vehicle collision trauma with concurrent severe extremity fractures and soft tissue injuries. This provides distal perfusion while surgeons assess/fixate the limb. TIVS are placed relatively uncommonly by a large number of trauma centers with a few hospitals using them much more frequently for penetrating injuries.

The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016

2017 ◽  
Vol 157 (4) ◽  
pp. 602-607 ◽  
Author(s):  
Alexander Lanigan ◽  
Brentley Lindsey ◽  
Stephen Maturo ◽  
Joseph Brennan ◽  
Adrienne Laury
Keyword(s):  
Soft Tissue ◽  
Tertiary Care ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Published Data ◽  
Care Hospital ◽  
Neck Injuries ◽  
Facial Fractures ◽  
Tympanic Membrane Perforations ◽  
Tissue Injuries

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

scholarly journals A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

2015 ◽  
Vol 6 (03) ◽  
pp. 315-319 ◽  
Author(s):  
Rodrigo Ramos-Zúñiga ◽  
Laura Rocío Díaz-Guzmán ◽  
Shannen Velasquez ◽  
Ana Magdalena Macías-Ornelas ◽  
Martín Rodríguez-Vázquez
Keyword(s):  
Soft Tissue ◽  
Case Control Study ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Radical Change ◽  
Case Control ◽  
Retrospective Case ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Control Study

Abstract Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

Pediatric Head and Neck Trauma from All-Terrain Vehicle Accidents

2007 ◽  
Vol 137 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Brian S. Wang ◽  
Stacey L. Smith ◽  
Kevin D. Pereira
Keyword(s):  
Soft Tissue ◽  
Head And Neck ◽  
Pediatric Trauma ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Neck Trauma ◽  
Retrospective Case ◽  
Average Hospital ◽  
Maxillofacial Fractures ◽  
Head And Neck Trauma

OBJECTIVE: To characterize pediatric head and neck trauma from all-terrain vehicles (ATVs) at a single institution. STUDY DESIGN/SETTING: Retrospective case series at a level I pediatric trauma center. RESULTS: Thirty-four patients were admitted: average age was 12 years, with 68% between 12 and 16 years and 32% under 12 years. The patient was the driver in 74% of cases and the passenger in 17% of cases. Driver average age was 12.7 years and passenger average age was 10.5 years. Seventy-six percent of children were not wearing helmets. Average hospital stay was 6 days, with 81% of cases discharged home. Central nervous system injuries were most common, followed by soft tissue injuries. Soft tissue repair was the most frequent procedure, and most maxillofacial fractures required operative intervention. CONCLUSIONS: ATV-related morbidity and mortality in children are significant public health issues amenable to primary prevention by prohibiting passengers on ATVs and requiring helmet use. SIGNIFICANCE: National trends indicate increasing ATV-related injuries in children.

In the emergency department

2018 ◽  
Author(s):  
Luke Cascarini ◽  
Clare Schilling ◽  
Ben Gurney ◽  
Peter Brennan
Keyword(s):  
Soft Tissue ◽  
Bone Fractures ◽  
Maxillofacial Surgery ◽  
Soft Tissue Injuries ◽  
Oral And Maxillofacial Surgery ◽  
Mandibular Fractures ◽  
Soft Tissue Infections ◽  
Penetrating Injuries ◽  
Orbital Floor Fractures ◽  
Zygomatic Fractures

This chapter discusses oral and maxillofacial surgery in the A&E department, including, The paediatric OMFS patient, Overview of maxillofacial trauma, Mandibular fractures, Zygomatic fractures, Orbital floor fractures, Maxillary fractures, Nose, naso-ethmoidal, and frontal bone fractures, Face and scalp soft tissue injuries, Penetrating injuries to the neck, Intra-oral injuries, Dento-alveolar trauma, Dento-alveolar infections, Post-extraction complications, Head and neck soft tissue infections, Salivary gland diseases, and Miscellaneous conditions

scholarly journals MANAGEMENT OF SOFT TISSUE INJURIES – CASE SERIES

2015 ◽  
Vol 05 (01) ◽  
pp. 079-082
Author(s):  
Muralee Mohan ◽  
B Rajendra Prasad ◽  
S M Sharma ◽  
Tripthi Shetty ◽  
Priyadharsana P S.
Keyword(s):  
Soft Tissue ◽  
Composite Structures ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Tissue Handling ◽  
Aesthetic Sense ◽  
Life Threatening ◽  
Tissue Injuries ◽  
And Function

AbstractSoft tissue injuries, whether isolated or in combination with other injuries, are amongst the most common traumatic craniofacial injuries encountered in our day to day practice.Soft tissue injuries may involve the skin, subcutaneous tissue, underlying muscle or a combination of any of these elements. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patients' facial aesthetics and function. Hence one should know the “do's and don'ts”.Disfigurement following trauma, has a detrimental effect on the victim's personality and future. Therefore such cases should be most appropriately managed with thorough knowledge of applied anatomy, an aesthetic sense and meticulous tissue handling, along with surgical skills to repair composite structures.

Effects of Hip Arthroscopy Without a Perineal Post on Venous Blood Flow, Muscle Damage, Peripheral Nerve Conduction, and Perineal Injury: A Prospective Study

2019 ◽  
Vol 47 (8) ◽  
pp. 1931-1938 ◽  
Author(s):  
K. Linnea Welton ◽  
Tigran Garabekyan ◽  
Matthew J. Kraeutler ◽  
Laura A. Vogel-Abernathie ◽  
Daniel Raible ◽  
...  
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Tissue Damage ◽  
Nerve Conduction ◽  
Hip Arthroscopy ◽  
Venous Blood ◽  
Venous Blood Flow ◽  
Perineal Injury ◽  
D Dimer

Background: Prior reports of hip arthroscopy using a perineal post have established the risks of groin soft tissue injury, sexual dysfunction, and altered lower extremity neurovascular function. These parameters have not been investigated for hip arthroscopy without the use of a perineal post. Purpose: To evaluate the effects of postless hip arthroscopy on lower extremity venous blood flow, nerve conduction, muscle tissue damage, and perineal injury. Study Design: Case series; Level of evidence, 4. Methods: Patients between the ages of 18 and 50 years undergoing an elective unilateral or simultaneous bilateral hip arthroscopy were enrolled. Creatine phosphokinase (CPK)–MM levels and D-dimer levels were obtained preoperatively, immediately postoperatively, and 7 to 12 days postoperatively. Bilateral Doppler ultrasonography of the common femoral vein (CFV) and popliteal vein were conducted intraoperatively. Somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were measured intraoperatively for the lower limbs. Perineal injury was assessed at 7 to 12 days postoperatively. Results: 35 patients underwent a total of 40 hip arthroscopies. No significant differences were found in venous blood flow between the operative and nonoperative legs for either the CFV or popliteal vein. SSEP monitoring of the peroneal nerve showed no significant reduction when traction was applied to the operative leg, 90.8%, compared with final measurement just before it was removed, 72.4% ( P = .09). For TcMEPs measured in the muscles outside of the traction boots, no significant changes were seen in the percentage of cases with abnormal measurements throughout the procedure. CPK-MM levels preoperatively, immediately postoperatively, and 7 to 12 days after surgery were on average 112, 190, and 102 IU/L, respectively (normal, <156 IU/L). No significant relationship was found between abnormal venous flow and altered D-dimer levels. No clinical evidence of nerve or vascular injury was encountered, and no groin soft tissue complications were observed during the study period. Conclusion: Postless hip arthroscopy is safe, without a notable reduction of venous blood flow or alteration of nerve function in the operative leg. Muscle tissue damage is subclinical, transient, and reduced compared with distraction with a post. No cases of perineal injury were observed during the study period.

In the emergency department

2011 ◽  
pp. 59-104
Author(s):  
Luke Cascarini ◽  
Clare Schilling ◽  
Ben Gurney ◽  
Peter Brennan
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Bone Fractures ◽  
Soft Tissue Injuries ◽  
Frontal Bone ◽  
Maxillofacial Trauma ◽  
Mandibular Fractures ◽  
Penetrating Injuries ◽  
Orbital Floor Fractures ◽  
Zygomatic Fractures

OMFS in the emergency department 60 The paediatric OMFS patient 62 Overview of maxillofacial trauma 64 Mandibular fractures 66 Zygomatic fractures 70 Orbital floor fractures 72 Maxillary fractures 74 Nose, naso-ethmoidal, and frontal bone fractures 76 Face and scalp soft tissue injuries 78 Penetrating injuries to the neck ...

scholarly journals The use of pyloric exclusion for treating duodenal trauma: case series

2008 ◽  
Vol 126 (6) ◽  
pp. 337-341 ◽  
Author(s):  
Gustavo Pereira Fraga ◽  
Guilherme Biazotto ◽  
José Benedito Bortoto ◽  
Nelson Adami Andreollo ◽  
Mario Mantovani
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Hypovolemic Shock ◽  
Case Series ◽  
Gunshot Wounds ◽  
University Hospital ◽  
Morbidity Rate ◽  
Cross Sectional ◽  
Pyloric Exclusion

CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

scholarly journals RECONSTRUCTION OF UPPER LIMB SOFT TISSUE INJURIES, EXCEPT FOR FINGERTIPS LESIONS

2021 ◽  
Vol 29 (2) ◽  
pp. 81-86
Author(s):  
CARLOS ALBERTO EGUEZ JELSKI ◽  
GUSTAVO BALADORE SZENDLER ◽  
CRISTINA SCHMITT CAVALHEIRO ◽  
LUIZ ANGELO VIEIRA ◽  
EDIE BENEDITO CAETANO
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Free Flaps ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Reconstructive Procedures ◽  
Advantages And Disadvantages ◽  
Tissue Injuries

ABSTRACT Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps. Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series.

scholarly journals Incidence, Demographics, and Outcomes of Penetrating Trauma in Sweden During the Past Decade

2021 ◽  
Vol 12 ◽  
Author(s):  
Mattias Günther ◽  
Martin Dahlberg ◽  
Amir Rostami ◽  
Ali Azadali ◽  
Ulf P. Arborelius ◽  
...  
Keyword(s):  
Head Trauma ◽  
Interpersonal Violence ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Trauma Patients ◽  
National Council ◽  
Contributing Factors ◽  
Penetrating Injuries ◽  
Head Neck

Trauma injury is the sixth leading cause of death worldwide, and interpersonal violence is one of the major contributors in particular regarding injuries to the head and neck. The incidence, demographics, and outcomes of penetrating trauma reaching hospitals in Sweden are not known. We report the largest, nationwide epidemiological study of penetrating injuries in Sweden, using the Swedish Trauma Registry (SweTrau). A multi-center retrospective descriptive study of 4,776 patients was conducted with penetrating injuries in Sweden, between 2012 and 2018. Due to the increase in coverage of the SweTrau registry during the same period, we chose to analyze the average number of cases for the time intervals 2013–2015 and 2016–2018 and compare those trends to the reports of the Swedish National Council for Crime Prevention (Brå) as well. A total of 663 patients had Injury Severity Score (ISS) ≥ 15 at admission and were included in the study. Three hundred and sixty-eight (55.5%) were stab wounds (SW), 245 (37.0%) gunshot wounds (GSW), and 50 (7.5%) other traumas. A majority of the cases involved injuries to the head, neck, and face. SW increased from 145 during 2013–2015 to 184 during the second period of 2016–2018. The increase was greater for GSW from 92 to 141 during the same respective periods. This trend of increase over time was also seen in head, neck, and face injuries. The 30-day mortality was unaffected (48–47%) in GSW and trended toward lower in SW (24–21%) when comparing 2013–2015 with 2016–2018. Patients with head trauma had 45% mortality compared to 18% for non-head trauma patients. Head trauma also resulted in worse outcomes, only 13% had Glasgow outcome score (GOS) 5 compared to 27% in non-head trauma. The increasing number of cases of both SW and GSW corresponded well with reports from Brå although further studies also are needed to address deaths outside of hospitals and not registered at the SweTrau. The majority of cases had injuries to the head, neck, and face and were associated with higher mortality and poor outcomes. Further studies are needed to understand the contributing factors to these worse outcomes in Sweden and whether more targeted trauma care of these patients can improve outcomes.

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