scholarly journals RESULTS OF SURGICAL TREATMENT OF FIRE WOUNDS OF COLON

2021 ◽  
pp. 52-56
Author(s):  
K. V. Gumeniuk ◽  
I. P. Marcinkovsky ◽  
G. L. Bogush ◽  
V. G. Verdesh
Keyword(s):  
Surgical Treatment ◽  
Medical Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Gunshot Wounds ◽  
Multi Stage ◽  
Post Traumatic ◽  
Adhesive Intestinal Obstruction ◽  
The Right ◽  
Colon Injuries

The aim of the study. Evaluate the results of surgical treatment of wounded with gunshot wounds of the colon. Materials and methods of research. A retrospective analysis of the results of surgical treatment of 32 wounded with gunshot wounds of the colon, who were treated in the Central Medical Center and area of responsibility (II–IV level of medical care) from 2014 to 2017. Damage to the right half of the colon was observed in 12 wounded (37.4 %), the left half — in 17 (53.2 %), the rectum — in 3 (9.4 %). A differentiated approach to surgical treatment of colon injuries of different localization is applied. Results and discussion. The method of multi-stage surgical treatment “Damage Control Surgery” was used in 12.5 % of patients. The most common complications of the injury were adhesive intestinal obstruction in 6.3 % of cases, the formation of intestinal abscesses — in 6.3 %, the development of post-traumatic pneumonia in 25 % of patients. Conclusions. If the tactics of “Damage Control Surgery” are followed, it is possible to improve the results of surgical treatment of colon injuries in severe and extremely severe patients.

scholarly journals Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

2017 ◽  
Vol 11 (1) ◽  
pp. 190-200
Author(s):  
Satoshi Koizumi ◽  
Kenta Katsumata ◽  
Tatsunori Ono ◽  
Kouhei Segami ◽  
Hiroyuki Hoshino ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Liver Trauma ◽  
Control Procedure ◽  
Severe Liver ◽  
Hepatic Hilus ◽  
Initial Strategy ◽  
Glissonean Pedicle ◽  
Definitive Surgery

The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

scholarly journals Management of Destructive Colon Injuries after Damage Control Surgery

2017 ◽  
Vol 31 (01) ◽  
pp. 036-040 ◽  
Author(s):  
Priya Prakash ◽  
William Symons ◽  
Jad Chamieh
Keyword(s):  
World War Ii ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Fecal Diversion ◽  
Trauma Patients ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
Life Threatening ◽  
Colon Injuries

AbstractAfter the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results. Studies have revealed good outcomes in those undergoing anastomosis after damage control surgery; however, they point to a subgroup of trauma patients considered to be “high risk” that may benefit from fecal diversion. Risk factors influencing morbidity and mortality rates include hypotension, massive transfusion, the degree of intra-abdominal contamination, associated organ injuries, shock, left-sided colon injury, and multiple comorbid conditions. Patients who are not suitable for anastomosis by 36 hours after damage control may be best managed with a diverting stoma. Failures are more likely related to ongoing instability, and the management strategy of colorectal injury should be based mainly on the patient's overall condition.

scholarly journals Contemporary damage control surgery outcomes: 80 patients with severe abdominal injuries in the right upper quadrant analyzed

2017 ◽  
Vol 44 (1) ◽  
pp. 79-85 ◽  
Author(s):  
M. Hommes ◽  
S. Chowdhury ◽  
D. Visconti ◽  
P. H. Navsaria ◽  
J. E. J. Krige ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Injuries ◽  
Surgery Outcomes ◽  
The Right

scholarly journals Stage Reconstructive and Restorative Surgical Treatment of Gunshot Wounds of the Groin, Scrotum and Penis (Case Report)

Health of Man ◽  
2021 ◽  
pp. 85-90
Author(s):  
Serhii Golovko ◽  
Oleksandr Savytskiy ◽  
Oleksandr Netrebko ◽  
Yevhen Bidula ◽  
Volodymyr Bondarchuk
Keyword(s):  
Surgical Treatment ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Initial Stage ◽  
The Right ◽  
Upper Third ◽  
Tissue Defects

The frequency of external genital lesions in armed conflicts can reach up to 5%. The complexity of gunshot wounds is the presence of significant soft tissue defects, widespread necrosis around the wound, the possibility of progression in the hours and days after injury, the high probability of infection, and the presence of foreign bodies. The tactics of gunshot wounds are determined by the location, nature and extent of damage to soft tissues, organs, large vessels, nerves, bones and includes several stages. At the initial stage, bleeding is stopped, hematomas and foreign bodies are evacuated, non-viable tissues are removed, drainages are installed and skin defects are closed. The stage of reconstructive surgery can be started when the active wound process is over. In this report, we present a clinical case of a 22-year-old man who received a gunshot wound to the right groin, upper third of the right thigh, perineum and external genitalia in a combat zone of Operation Allied Forces, Ukraine. Bullet wound led to: damage to the skin and subcutaneous tissue in the right buttock, right groin, on the inner surface of the upper third of the thigh, penis (skin defect up to 1/3 of the circumference), scrotum, partial destruction of corpora cavernosa, m. iliopsoas and adductor muscles of the thigh, sphincter of the rectum, crushing of the right testicle. The wound was contaminated with earth and foreign bodies At the initial stage, the patient underwent: primary surgical treatment of a gunshot wound, suturing of cavernous bodies with sutures, fixation of the penis in the groin, removal of the right testicle, tamponade of the wound, sigmostomy (due to sphincter damage). Subsequently, the patient underwent regular surgical treatment of wounds, a vacuum suction system VAC was installed. After 7 months (upon completion of the healing process) suturing of the sigmostoma was performed. After 2 months, the penis and the scrotum were reconstructed. Preoperative examination (ultrasound of the penis with assessment of cavernous hemodynamics, MRI) revealed: post-traumatic scarring of the soft tissues of the right groin, inner surface of the right thigh, buttocks, right inguinal canal of the penis and scrotum, deformation of the cavernous cavity, normal indicators of cavernous blood circulation. In the early postoperative period (2 months after the intervention), the patient indicated satisfaction with the cosmetic and functional results, the preservation of morning erections, moderate discomfort in the penis during erection. Prosthetics of the right testicle are planned. The clinical case once again confirms the need for qualified surgical care during the first “golden” hour and subsequent phased treatment at a specialized level using the VAC therapy system in patients with gunshot wounds and large soft tissue defects. The experience of military medicine demonstrates the importance of involving specialists of various profiles in the treatment of combined gunshot wounds of the pelvis. An important stage of treatment in the wounded is plastic and reconstructive surgery in the long term, which is aimed at improving the functional, cosmetic and psychological results of treatment.

Surgical treatment of combined thoraco-abdominal injury of liver with the mechanism of the hydrodynamic shock (case report)

2017 ◽  
Vol 86 (3) ◽  
pp. 240
Author(s):  
Ievgen Tsema ◽  
Igor Khomenko ◽  
Vitalii Shapovalov ◽  
Georgii Makarov ◽  
Roman Palytsia ◽  
...  
Keyword(s):  
Medical Care ◽  
Damage Control ◽  
Abdominal Cavity ◽  
Penetrating Trauma ◽  
Liver Parenchyma ◽  
Clear Understanding ◽  
Medical Evacuation ◽  
Post Traumatic ◽  
The Right ◽  
Vascular Suture

This article presents a clinical case of successful multilevel treatment the combined gunshot wound of liver with the mechanism of hydrodynamic shock using «damage control» tactic. The patient received a combined thoraco‑abdominal injured as a result of warfare on the east of Ukraine. The blind fragmental penetrating trauma of the chest cavity led to the rupture of the right dome of diaphragm and liver (S3–S6) by the mechanism of hydrodynamic kick (fragments the wreckage and input/output openings in the abdominal cavity were not found). The «damage control» tactic was implemented as follows. On the second level of medical care the rupture of the liver parenchyma eliminated by repeated firmwares with omentopexy. The post‑traumatic period proceeded with the several consecutive complications: cutting the liver sutures, the arrosive bleeding from the right hepatic artery and the irreversible ischemia of the liver S5-S6. These complications were liquidated gradually on the IV level of medical care by the transpupillary choledochal stenting, vascular suture and the imposition of a typical anatomical resection of liver S5–6. Successful treatment of patients with the severe fragmental gunshot thoraco‑abdominal injuries should be based on a clear understanding of the stages of traumatic disease and expected complications of parallel conduct medical evacuation, using «damage control» tactic on the all levels of medical care.

scholarly journals Successful Management of Internal Carotid Artery Transection Secondary to a Gunshot Wound and Subsequent Malignant MCA Syndrome

2021 ◽  
pp. 276-283
Author(s):  
George Cairns ◽  
Alex Belshaw
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Gunshot Wound ◽  
Internal Carotid ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Gunshot Wounds ◽  
High Rate ◽  
Major Surgery ◽  
Artery Ligation

There are over 100,000 strokes each year in the UK. A very small proportion of these can be attributed to gunshot wounds and subsequent surgical intervention. We present a rare case of a 24-year-old male patient admitted to the Emergency Department having sustained a gunshot wound to the left side of his neck. Initial imaging and surgical exploration revealed significant left-sided vertebral artery damage and a complete transection of the internal carotid artery. Following damage control surgery (DCS), the patient was admitted to ITU but had an acute neurological deterioration and was found to have suffered malignant middle cerebral artery (MCA) syndrome, requiring an urgent decompressive craniectomy. The patient’s National Institutes of Health Stroke Scale (NIHSS) at this stage was 26. After a prolonged ITU stay and repatriation to a local stroke unit for intensive therapies input, the patient walked out of the hospital independently on day 106, with an improved NIHSS of 3. This case report aims to highlight the rarity of an ischaemic stroke, secondary to the DCS required for a near fatal gunshot wound, along with the importance of timely recognition of an acute deterioration following artery ligation. Additionally, it aims to examine the lifesaving surgical management of malignant MCA syndrome and in turn the significance of the shared decision-making process between clinicians, the patient, and family members, due to the high rate of poor functional outcomes following this major surgery.

scholarly journals PERIARTICULAR CYSTS OF FACET JOINTS: ETIOPATHOGENESIS, DIAGNOSIS, METHODS OF SURGICAL TREATMENT. A CLINICAL EXAMPLE

2018 ◽  
Vol 3 (4) ◽  
pp. 61-68 ◽  
Author(s):  
V. A. Byvaltsev ◽  
V. A. Sorokovikov ◽  
A. A. Kalinin ◽  
A. K. Okoneshnikova
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina ◽  
Facet Joints ◽  
Medical Databases ◽  
Current State ◽  
Relevant Topic ◽  
Post Traumatic ◽  
Cauda Equina Roots ◽  
The Right ◽  
Significant Factors

Background. Periarticular cysts (PC) of facet joints is a rare pathology in neurosurgical practice. The concept of PC is applicable for all cysts that are located either pararticularly in the region of facet joints, or start from them.Material and methods. A systematic search was performed in medical databases: Medline, RINC, EMedicine, UMKB, Pubmed on the relevant topic in Russian and English. The search query includes  words: arcuate joint, periarticular cyst, clinic, diagnosis, surgical  treatment. One of the significant factors of PC development is the  instability of the vertebralmotor segment of both degenerative and post-traumatic character.Results. The result of the literature review was the writing of a clinical lecture, the current state of the issue of etiopathogenesis, diagnosis and management of patients with  periarticular cysts of facet joints was studied. The article gives a  clinical example of surgical treatment of a patient with a periarticular cyst at the level of LIV-LV on the right.Conclusion. Periarticular cysts of facet joints are one of the factors of compression of cauda equina roots, with surgical treatment being  a radical and effective way of treatment. A detailed study of this  pathology is a promising direction in spinal neurosurgery. Further  research is required on comparative analysis of clinical and  instrumental efficacy of various methods of surgical treatment of periarticular cysts of facet joints.

scholarly journals REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Fernando Rodriguez ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
New Technology ◽  
Management Strategies ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Hemostatic Resuscitation ◽  
The Right ◽  
Trauma Surgeons

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

scholarly journals Aortic Arch Hypoplasia in Infants: Algorithm of Diagnosis and Treatment

2020 ◽  
pp. 73-78
Author(s):  
I. Truba ◽  
I. Dzyurii ◽  
L. Prokopovych ◽  
V. Lazoryshynets
Keyword(s):  
Surgical Treatment ◽  
Aortic Arch ◽  
Heart Diseases ◽  
Surgical Approaches ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Multi Stage ◽  
Practical Standpoint ◽  
The Right ◽  
Aortic Arch Hypoplasia

  Background. Aortic arch hypoplasia is a congenital anomaly of the development of the aortic arch characterized by hemodynamically significant narrowing of one or more segments of the aortic arch. Despite the great interest in the problem of aortic arch hypoplasia, there are many contradictions in terms of terminology and classification. It is quite difficult to draw a clear line between normal physiology and pathology to determine in which cases there is a true hypoplasia, so, from a practical standpoint, the fundamental issue is the selection of criteria with reference to which we can talk about clinically and prognostically significant aortic arch hypoplasia. Important and yet controversial are the issues of multi-stage treatment of aortic arch hypoplasia and concomitant congenital heart diseases (CHD), and, in case of the isolated variant of hypoplasia, the choice of surgical approach. The aim of the study was to discuss different strategies and surgical approaches for patients with aortic arch hypoplasia, with an emphasis on surgical solutions and based on many years of experience, to develop an algorithm for diagnostic and surgical treatment of the aortic arch hypoplasia in infants. Conclusions. Aortic arch hypoplasia in infants remains a complicated issue in pediatric cardiac surgery. The variety of anatomical forms of isolated aortic arch hypoplasia and common overlap with other CHD raises many questions for the cardiac surgeon. Decisions concerning diagnosis and choice of further treatment tactics made in the neonatal period will affect not only the immediate but also the long-term outcome in the future. The algorithm of diagnostic and patient management with aortic arch hypoplasia allows to make the right timely decision which will affect the outcome of surgical treatment of this complex pathology.

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