Extracorporeal sheath shunt technique in trauma: A different vascular shunt in civilian trauma

Vascular ◽  
2021 ◽  
pp. 170853812110011
Author(s):  
Luís F. Antunes ◽  
Mafalda Botelho ◽  
Manuel Fonseca
Keyword(s):  
Surgical Approach ◽  
Damage Control ◽  
Vascular Reconstruction ◽  
Arterial Injury ◽  
Military Surgery ◽  
New Approach ◽  
Civilian Trauma ◽  
Open Management ◽  
Reduced Time ◽  
Civilian Practice

Background/Objective Temporary intravascular shunts are widely used in military surgery, representing a bridging until definitive vascular reconstruction. In civilian practice, shunts are mainly used as damage control and as a temporary measure until orthopaedic fixation. The objective of this report is to illustrate a new approach to the temporary restoration of perfusion during open management of extremity arterial injury. Methods The authors present a technique that uses sheaths introducers, instead of commercial or purpose-built shunts, which can be used through surgical or percutaneous approaches. Three clinical cases are presented where this technique was performed. Results/Conclusion: In the presented cases, this technique reduced time of shunt construction by avoiding artery surgical approach. This technique can facilitate the creation of an intravascular shunt among other than vascular surgeons.

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

A Surgical Approach to the Treatment of Permanent Incisor Teeth in Infra-Occlusion: Two Case Reports

1974 ◽  
Vol 1 (5) ◽  
pp. 237-239
Author(s):  
R. K. Rayson ◽  
W. J. B. Houston ◽  
G. L. Howe
Keyword(s):  
Surgical Approach ◽  
Orthodontic Treatment ◽  
Case Reports ◽  
Central Incisor ◽  
Incisor Tooth ◽  
New Approach

Two cases of infra-occlusion of a permanent upper central incisor tooth are described. Both cases were successfully treated by dento-alveolar surgery. This new approach offers a solution to cases of the type described where conventional orthodontic treatment cannot succeed.

Comparison of Abdominal Damage Control Surgery in Combat Versus Civilian Trauma

2010 ◽  
Vol 69 (Supplement) ◽  
pp. S168-S174 ◽  
Author(s):  
Chitra N. Sambasivan ◽  
Samantha J. Underwood ◽  
S. D. Cho ◽  
Laszlo N. Kiraly ◽  
Greg J. Hamilton ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Civilian Trauma

A critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma

2020 ◽  
pp. bmjmilitary-2020-001508 ◽  
Author(s):  
Amila S Ratnayake ◽  
M Bala ◽  
C J Fox ◽  
A U Jayatilleke ◽  
S P B Thalgaspitiya ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Vascular Reconstruction ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Large Animal ◽  
Vascular Injuries ◽  
Skeletal Trauma ◽  
Anatomy And Physiology ◽  
Arterial Injuries ◽  
The Impact

ObjectiveFor more than half a century, surgeons who managed vascular injuries were guided by a 6-hour maximum ischaemic time dogma in their decision to proceed with vascular reconstruction or not. Contemporary large animal survival model experiments aimed at redefining the critical ischaemic time threshold concluded this to be less than 5 hours. Our clinical experience from recent combat vascular trauma contradicts this dogma with limb salvage following vascular reconstruction with an average ischaemic time of 6 hours.MethodsDuring an 8-month period of the Sri Lankan Civil War, all patients with penetrating extremity vascular injuries were prospectively recorded by a single surgeon and retrospectively analysed. A total of 76 arterial injuries was analysed for demography, injury anatomy and physiology, treatment and outcomes. Subsequent statistical analysis was performed to evaluate the impact of independent variables to include; injury anatomy, concomitant venous, skeletal trauma, shock at presentation and time delay from injury to reconstruction.ResultsIn this study, the 76 extremity arterial injuries had a median ischaemic time of 290 (IQR 225–375) min. Segmental arterial injury (p=0.02), skeletal trauma (p=0.05) and fasciotomy (p=0.03) were found to have a stronger correlation to subsequent amputation than ischaemic time.ConclusionsMultiple factors affect limb viability following compromised distal circulation and our data show a trend towards various subsets of limbs that are more vulnerable due to inherent or acquired paucity of collateral circulation. Early identification and prioritisation of these limbs could achieve functional limb salvage if recognised. Further prospective research should look into the clinical, biochemical and morphological markers to facilitate selection and prioritisation of limb revascularisation.

Deformation of Angle Profiles in Forward Kinematics for Nullifying End-Point Offset While Preserving Movement Properties

2002 ◽  
Vol 124 (5) ◽  
pp. 490-495 ◽  
Author(s):  
Xudong Zhang
Keyword(s):  
Empirical Evaluation ◽  
Human Movement ◽  
Forward Kinematics ◽  
Movement Model ◽  
New Approach ◽  
End Point ◽  
Position Errors ◽  
Significant Difference ◽  
Movement Representation ◽  
Reduced Time

This work describes a new approach that allows an angle-domain human movement model to generate, via forward kinematics, Cartesian-space human movement representation with otherwise inevitable end-point offset nullified but much of the kinematic authenticity retained. The approach incorporates a rectification procedure that determines the minimum postural angle change at the final frame to correct the end-point offset, and a deformation procedure that deforms the angle profile accordingly to preserve maximum original kinematic authenticity. Two alternative deformation schemes, named amplitude-proportional (AP) and time-proportional (TP) schemes, are proposed and formulated. As an illustration and empirical evaluation, the proposed approach, along with two deformation schemes, was applied to a set of target-directed right-hand reaching movements that had been previously measured and modeled. The evaluation showed that both deformation schemes nullified the final frame end-point offset and significantly reduced time-averaged position errors for the end-point as well as the most distal intermediate joint while causing essentially no change in the remaining joints. A comparison between the two schemes based on time-averaged joint and end-point position errors indicated that overall the TP scheme outperformed the AP scheme. In addition, no statistically significant difference in time-averaged angle error was identified between the raw prediction and either of the deformation schemes, nor between the two schemes themselves, suggesting minimal angle-domain distortion incurred by the deformation.

scholarly journals Evidence for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients: A Systematic Review

2020 ◽  
Author(s):  
Derek J. Roberts ◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
Chad G. Ball ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background: Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes).Methods: We searched 11 databases (1950-April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results: Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring >10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications.Conclusions: Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

scholarly journals A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients

BMJ Open ◽  
2014 ◽  
Vol 4 (7) ◽  
pp. e005634-e005634 ◽  
Author(s):  
D. J. Roberts ◽  
D. A. Zygun ◽  
A. W. Kirkpatrick ◽  
C. G. Ball ◽  
P. D. Faris ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Civilian Trauma
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