scholarly journals Experimental evaluation of the effectiveness of a damage control surgery in combined radiation-mechanical injuries

2019 ◽  
pp. 98-105
Author(s):  
A. B. Seleznev ◽  
A. M. Nosov ◽  
V. A. Kozyaev ◽  
A. N. Grebenyuk
Keyword(s):  
Blood Loss ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Laboratory Animals ◽  
Average Life Expectancy ◽  
Behavioral Reactions ◽  
Early Total Care ◽  
Proposed Model ◽  
Total Care ◽  
Care Surgery

Relevance. Currently, damage control surgery (DCS) is actively used in polytrauma. However, data on the effectiveness of this tactic for combined radiation-mechanical injuries (CRMI) in the available literature was not found.Objective. To develop a model of CRMI on small laboratory animals (rabbits), which allows studying the effectiveness of the use of DCS in comparison with the early total care surgery tactics.Methods. A model of a severe CRMI was proposed. The animals were subjected to a generally uniform short-term gammairradiation, and then they suffered a liver injury on the background of blood loss of 40% of the blood volume and hypothermia. After modeling the lesion, a comparison was made of the effectiveness of the tactics of the DCS and the early total care surgery tactics. During the study, the following indicators were evaluated: the average life expectancy and mortality of animals, changes in the cellular composition of peripheral blood, features of behavioral reactions to irradiation, the amount of blood loss during the implementation of the surgical intervention.Results and their analysis. The experiment showed that the tactics of the DCS have an advantage over the traditional tactics of a one-time exhaustive operation in the case of the CRMI. When performing DCS, there was no death of rabbits on the 1st day after the operation, when implementing early total care surgery - 3 rabbits died, besides, the mortality was absolute, while with DCS one rabbit survived (12.5%). The final operation at the DCS occurs prior to the beginning of the acute period of CRMI, which corresponds to the requirements of the instructions for the treatment of CRMI. In the course of the study, it was found that the proposed model of CRMI contributes to the formation of the phenomenon of mutual burdening and, as a result, complicates both the radiation and mechanical components of the lesion occurs.Conclusion The proposed experimental model for the application of severe CRMI helps to explore DCS tactics in the treatment of this pathology. DCS is a promising method of surgical treatment of CRMI, however, for more accurate extrapolation of data from animal to human, additional research on large laboratory animals is required. 

Timing of Fracture Fixation in Multitrauma Patients: The Role of Early Total Care and Damage Control Surgery

2009 ◽  
Vol 17 (9) ◽  
pp. 541-549 ◽  
Author(s):  
Hans-Christoph Pape ◽  
Paul Tornetta ◽  
Ivan Tarkin ◽  
Christopher Tzioupis ◽  
Vani Sabeson ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Early Total Care ◽  
Total Care

scholarly journals The choice of tactics for treatment of the injured persons with vertebra-abdominal trauma due to traffic-transport accident

2019 ◽  
Vol 86 (6) ◽  
pp. 30-33
Author(s):  
S. О. Guryev ◽  
P. V. Таnasiyenko ◽  
S. Ya. Balyasevych
Keyword(s):  
Abdominal Trauma ◽  
Traffic Accident ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mortality Reduction ◽  
Early Total Care ◽  
Group I ◽  
Treatment Measures ◽  
Total Care ◽  
Group Ii

Objective. To estimate the results of application of treatment-diagnostic tactics in the injured persons, suffering vertebro-abdominal trauma as a consequence of the traffic accident. Маterials and methods. For achievement of the investigation aim 122 injured persons with vertebro-abdominal trauma due to traffic accident were analyzed. The injured persons were divided into two Groups: Group I - 53 patients, in whom the «early total care» was applied, and Group II (a control one) - 69 patients, to whom the treatment measures were conducted in accordance to the «damage control surgery» tactics. Results. In the investigation there was established, that in the injured persons, suffering vertebro-abdominal trauma two tactics are affordable: «early total care», which is indicated in moderate internal hemorrhage, injuries of large omentum and intestinal mesentery, and «damage control surgery», which is indicated in presence of severe internal hemorrhage, hepatic, splenic and the retroperitoneal organs damages. Conclusion. Application of the «damage control surgery» tactics in the injured persons, suffering vertebro-abdominal trauma has advantages, what is proved by the mortality reduction by 6.3% and the rate of the infection complications occurrence - by 3.5%.

scholarly journals Training in the practical application of damage control and early total care operative philosophy – perceptions of UK orthopaedic specialist trainees

2010 ◽  
Vol 92 (2) ◽  
pp. 154-158 ◽  
Author(s):  
WGP Eardley ◽  
DM Taylor ◽  
PJ Parker
Keyword(s):  
External Fixation ◽  
Damage Control ◽  
Practical Application ◽  
Web Based ◽  
High Exposure ◽  
Orthopaedic Surgeons ◽  
Early Total Care ◽  
Total Care ◽  
High Level ◽  
Optimum Management

INTRODUCTION Despite improvements in the outcome of individuals sustaining significant injury, the optimum management of fractures in traumatised patients remains an area of debate and publication. There is, however, a paucity of studies regarding the specifics of acquired experience and training of junior orthopaedic surgeons in the practical application of these skills. Our null hypothesis is that, despite alteration in surgical training, the perceived confidence and adequacy of training of UK orthopaedic specialist trainees in the application of damage control orthopaedics (DCO) and early total care (ETC) philosophy is unaffected. PATIENTS AND METHODS A web-based survey was sent to a sample of orthopaedic trainees. From 888 trainees, 222 responses were required to achieve a 5% error rate with 90% confidence. RESULTS A total of 232 responses were received. Trainees reported a high level of perceived confidence with both external fixation and intramedullary devices. Exposure to cases was sporadic although perceived training adequacy was high. A similar pattern was seen in perceived operative role with the majority of trainees expecting to be performing such operations, albeit under varying levels of supervision. In a more complicated case of spanning external fixation for a ‘floating knee, trainees reported a decreased level of perceived confidence and limited exposure. One-third of trainees reported never having been involved in such a case. In contrast to nationally collated logbook data, exposure to and perceived confidence in managing cases involving ETC and DCO were similar. CONCLUSIONS Despite changes in the training of junior orthopaedic surgeons, trainee-reported confidence and adequacy of training in the practical application of DCO and ETC was high. Exposure to cases overall was, however, seen to be limited and there was a suggestion of disparity between current operative experiences of trainees and that recorded in the national trainee logbook.

Early Total Care (ETC) im Vergleich zu Damage Control Orthopedics (DCO) bei der Behandlung polytraumatisierter Patienten mit Femurschaftfrakturen

2010 ◽  
Vol 113 (11) ◽  
pp. 923-930 ◽  
Author(s):  
T. Stübig ◽  
P. Mommsen ◽  
C. Krettek ◽  
C. Probst ◽  
M. Frink ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Orthopedics ◽  
Early Total Care ◽  
Total Care

Borderline femur fracture patients: early total care or damage control orthopaedics?

2010 ◽  
Vol 81 (3) ◽  
pp. 148-153 ◽  
Author(s):  
Ben Nicholas ◽  
Laszlo Toth ◽  
Karlijn van Wessem ◽  
Julie Evans ◽  
Natalie Enninghorst ◽  
...  
Keyword(s):  
Femur Fracture ◽  
Damage Control ◽  
Damage Control Orthopaedics ◽  
Early Total Care ◽  
Total Care

Damage-Control Orthopedics Versus Early Total Care in the Treatment of Borderline High-Energy Pelvic Fractures

Orthopedics ◽  
2014 ◽  
Vol 37 (12) ◽  
pp. e1091-e1100 ◽  
Author(s):  
Gengfen Han ◽  
Ziming Wang ◽  
Quanyin Du ◽  
Yan Xiong ◽  
Yu Wang ◽  
...  
Keyword(s):  
Damage Control ◽  
High Energy ◽  
Pelvic Fractures ◽  
Damage Control Orthopedics ◽  
Early Total Care ◽  
Total Care

Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

2004 ◽  
Vol 18 (Supplement) ◽  
pp. S13-S23 ◽  
Author(s):  
Hans-Christoph Pape ◽  
Frank Hildebrand ◽  
Stephanie Pertschy ◽  
Boris Zelle ◽  
Rayeed Garapati ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Damage Control ◽  
Femoral Shaft ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Early Total Care ◽  
Total Care ◽  
Polytrauma Patients

Coagulation management in major trauma

2006 ◽  
Vol 26 (S 02) ◽  
pp. S50-S55 ◽  
Author(s):  
H. Schoechl
Keyword(s):  
Blood Loss ◽  
Major Trauma ◽  
Damage Control ◽  
Coagulation Factor ◽  
Damage Control Surgery ◽  
Coagulation Factors ◽  
Conclusive Evidence ◽  
Trauma Patients ◽  
Coagulation Management ◽  
Haemostatic Agents

SummaryBleeding is a common problem in major trauma. Coagulopathy could be detected in approximately 25% of all trauma patients on arrival in the emergency room. The reasons for that are blood loss, dilution of the remaining coagulation factors by fluids not containing coagulation factors, consumption of coagulation factors and hyperfibrinolysis. Hypothermia and acidosis are also well described contributors of coagulopathy.Diagnosis of coagulation abnormalities should be based on clinical judgement. Standard coagulation tests are universally available, but there is some evidence, that those tests are not predictive for transfusion requirement. Thrombelastography/ metry is a promising technology which not only shows the initiation of the coagulation process but also the dynamic of clot formation and the clot firmness. It is the golden standard for the diagnosis of hyperfibrinolysis. To restore adequate haemostasis an aggressive treatment of hypothermia and acidosis is essential. The concept of damage control surgery and permissive hypotension in server bleeding patients could reduce the whole amount of blood loss.For coagulation factor replacement therapy fresh frozen plasma, PCC, fibrinogen concentrates and cryoprecipitate could be used. Haematocrit should be maintained in the range of 30% and platelet count should not drop below 50 000/μl. In some circumstances haemostatic agents such as DDAVP, antifibrinolytics and rFVIIa could be helpful, even there is no conclusive evidence for the use of these drugs in severe trauma patients.

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