Penetrating Neck Trauma in a Level II Trauma Hospital, Saudi Arabia

Background. Penetrating neck trauma is a unique form of trauma that is on the rise all over the world and contributes significantly to high morbidity and mortality. Design. Retrospective and prospective case series. Setting. Urban, level II trauma hospital. Patients. Patients who had sustained penetrating trauma to the neck. Main Outcome Measures. The aim of this study was to evaluate the incidence, injury characteristics, and treatment outcome of penetrating neck trauma in our local setting and to suggest treatment protocols. Patients and Methods. This was a combined retrospective and prospective study of penetrating neck trauma patients who were managed at level II trauma hospital, Asceer region, Saudi Arabia, from March 2008 to March 2011. Results. A total of 49 patients were studied. Males outnumbered females by a ratio of 11.25:1. Their mean age (SD) was 31.1(12.6) years. Fourteen patients were caused by stab-wound injuries. Most injuries were in zone II (83.7%). More than one-third of patients were treated conservatively. Wound exploration and debridement were the mode of treatment in the majority of cases. The mean duration of hospital stay was 6.6 days (1–18 days). Mortality rate was 12.2%. Conclusion. The present paper illustrates the difficulties of managing penetrating neck injuries in our region, Saudi Arabia.

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Current Evidence Based Guidelines for Factor VIIa Use in Trauma: The Good, the Bad, and the Ugly

The American Surgeon ◽

10.1177/000313480807401206 ◽

2008 ◽

Vol 74 (12) ◽

pp. 1159-1165 ◽

Cited By ~ 4

Author(s):

Juan C. Duchesne ◽

Kavitha A. Mathew ◽

Alan B. Marr ◽

Michael R. Pinsky ◽

James M. Barbeau ◽

...

Keyword(s):

Case Reports ◽

Case Series ◽

Penetrating Trauma ◽

Cost Benefit ◽

Assessment Instrument ◽

Class I ◽

Factor Vii ◽

Current Evidence ◽

Trauma Patients ◽

Thromboembolic Events

Recombinant factor VII (rFVIIa) has arisen as an option for the control of life-threatening traumatic bleeding unresponsive to other means. The timing of administration, dosage, mortality, units of blood transfusion saved, risk of thrombotic events, and risk/benefits ratio are presently poorly defined. A Medline search from 1995 through March 2008 was conducted. All English language articles containing the terms “trauma” and “factor VII” or its variants were retrieved. Letters to the editor, animal studies, and general reviews were excluded. A total of 19 articles met inclusion criteria. These articles were then reviewed and stratified into three classes of evidence according to the quality assessment instrument developed by the Brain and Trauma Foundation. Levels of recommendation were developed. A total of 118 articles were identified. Only one Class I study was identified. This study demonstrated that three doses of rFVIIa given in blunt traumatic hemorrhage yielded a significant reduction of 2.6 of red blood cells used. These findings were not statistically significant for penetrating trauma patients. There was no reduction in mortality and no increase in thromboembolic events. Four Class II studies were identified; three showed a significant decrease of blood product usage and one demonstrated significant reductions in 24-hour and 30 day death from hemorrhage in patients receiving rFVIIa. The remaining 14 studies were Class III reviews of databases, registries, case series, and case reports. No identified study specifically addressed the cost/benefit analysis of rFVIIa usage in trauma hemorrhage. Utility of rFVIIa in trauma-associated hemorrhage remains controversial. There is Level I supporting the use of rFVIIa for blunt trauma patients only. There is no Class I evidence supporting decreased mortality or differences in thromboembolic events. Minimal effective dosing regimens and cost/benefit analyses have not yet been examined.

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Efficacy of Mobiderm® Bandage in Compression Therapy for Venous Ulcers: A Prospective Case Series

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211058273 ◽

2021 ◽

pp. 153473462110582

Author(s):

Harikrishna K.R. Nair ◽

Xian Lew ◽

Kong Yen Liew ◽

Siti Aishah Kamis ◽

Nik Muhamad Hakimi Nik Kub ◽

...

Keyword(s):

Case Series ◽

Compression Therapy ◽

High Morbidity ◽

Leg Ulcers ◽

Calf Circumference ◽

Mean Values ◽

Venous Leg Ulcers ◽

Venous Ulcers ◽

Wound Size ◽

Prospective Case Series

Background: Venous leg ulcers severely affect patients’ quality of life due to its high morbidity and recurrent nature. Currently, compression therapy is the first-line treatment for venous leg ulcers. Aim: This study sought to evaluate the efficacy of the Mobiderm® technology developed by Thuasne in a prospective case series of venous leg ulcers. Methods: Nine patients ( N = 9) with venous leg ulcers were enrolled into this case series. Mobiderm® bandage was applied on to the affected limbs of the patients in the multi-component bandages system. The bandages were changed as frequent as the patients had their wound dressing for their standard treatment in a 12-week duration. Wound size and calf circumference were measured at week 0 and week 12. Paired sample t-test was used to compare the mean values of wound size and calf circumference pre- and post-treatment. Results: Reductions in wound size and calf circumference were observed in all nine patients (100%). Five patients were evaluable at week 12. The wound sizes significantly reduced by 27.2% to 53.2% ( p = 0.02), and the calf circumferences significantly reduced by 3.2% to 26.0% ( p = 0.02) after 12 weeks ( N = 5). Safety was unremarkable, with no occurrence of treatment-emergent-related adverse event. Conclusion: Mobiderm® bandage was reported to be effective in promoting wound healing and reducing swelling, suggesting it to be integrated in the compression therapy for the management of venous leg ulcers.

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Scapulothoracic dissociation and blunt vertebral vascular injury: case report.

Colombia Medica ◽

10.25100/cm.v51i3.4386 ◽

2020 ◽

Author(s):

Neil Valentin Vega Peña ◽

Manuel Riveros Dueñas ◽

Angie Carolina Riscanevo Bobadilla

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Vertebral Artery ◽

Motor Vehicle ◽

Hypovolemic Shock ◽

Complex Case ◽

High Morbidity ◽

Neck Trauma ◽

Penetrating Neck Trauma ◽

Scapulothoracic Dissociation

Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient’s improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

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