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By Nisha Branch Surgical resident interested in disparities research.
Matthew Bradley, Samuel Galvagno, Amit Dhanda, Carlos Rodriguez, Margaret Lauerman, Joseph DuBose, Thomas Scalea, Deborah Stein
Although the use of damage control laparotomy (DCL) is well established, the effect of damage control resuscitation (DCR) on the management of open abdomens is relatively poorly studied. The aim of the present study was to determine the predictors for failure to achieve primary fascial closure (PFC) after DCL in the setting of a massive transfusion (MT) and DCR. This is a retrospective review over a 12-year period of all patients that underwent MT and DCL. Patients who achieved PFC were compared with those who did not (NPFC)...
August 2014: American Surgeon
Kristin L Long, David A Hamilton, Daniel L Davenport, Andrew C Bernard, Paul A Kearney, Phillip K Chang
Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA)...
June 2014: American Surgeon
Supparerk Prichayudh, Chayatat Sirinawin, Suvit Sriussadaporn, Rattaplee Pak-art, Kritaya Kritayakirana, Pasurachate Samorn, Sukanya Sriussadaporn
UNLABELLED: Management of liver injuries: Predictors for the need of operation and damage control surgery, INTRODUCTION: The advancement in the management of liver injuries, including the use of non-operative management (NOM), damage control surgery (DCS) and angiographic embolisation (AE); has resulted, in improvement of outcomes. The aim of this study is to analyse the outcome of liver injury patients in our institution and to identify predictors for the need of operative management (OM) and DCS...
September 2014: Injury
Being-Chuan Lin, Jen-Feng Fang, Ray-Jade Chen, Yon-Cheong Wong, Yu-Pao Hsu
INTRODUCTION: This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. MATERIALS AND METHODS: From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed...
January 2014: Injury
Naeem Goussous, Donald H Jenkins, Martin D Zielinski
OBJECTIVE: To compare the outcomes of patients undergoing damage control laparotomy (DCL) for intra-abdominal sepsis vs intra abdominal haemorrhage. We hypothesize that patients undergoing DCL for sepsis will have a higher rate of septic complications and a lower rate of primary fascial closure. SETTINGS AND PATIENTS: Retrospective study of patients undergoing DCL from December 2006 to November 2009. Data are presented as medians and percentages where appropriate...
January 2014: Injury
Joseph J Dubose, Thomas M Scalea, John B Holcomb, Binod Shrestha, Obi Okoye, Kenji Inaba, Tiffany K Bee, Timothy C Fabian, James Whelan, Rao R Ivatury
BACKGROUND: We conducted a prospective observational multi-institutional study to examine the natural history of the open abdomen (OA) after trauma and identify risk factors for failure to achieve definitive primary fascial closure (DPC) after OA use in trauma. METHODS: Adults requiring OA for trauma were enrolled during a 2-year period. Demographics, presentation, and management variables were used to compare primary fascial closure and non-primary fascial closure patients, with logistic regression used to identify independent risk factors for failure to achieve primary fascial closure...
January 2013: Journal of Trauma and Acute Care Surgery
Matthew J Martin, Quinton Hatch, Bryan Cotton, John Holcomb
BACKGROUND: Temporary abdominal closure (TAC) has become a widely used technique in severely injured patients. However, there is growing concern that TAC is being overutilized. We sought to identify less severely injured patients who underwent TAC and to compare their outcomes with patients managed with a single-stage laparotomy (SSL). METHODS: This is a analysis of all trauma patients who underwent immediate laparotomy from 2005 to 2009. Risk modeling identified TAC patients who met all low-risk criteria: systolic blood pressure >90, no severe head injury, no combined solid + hollow viscus injury, or vascular injury...
March 2012: Journal of Trauma and Acute Care Surgery
Ari K Leppäniemi, Panu J Mentula, Mari H Streng, Mika P Koivikko, Lauri E Handolin
BACKGROUND: Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. METHODS: In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients...
December 2011: World Journal of Surgery
Shigeki Kushimoto, Masato Miyauchi, Hiroyuki Yokota, Makoto Kawai
The concept of damage control and improved understanding of the pathophysiology of abdominal compartment syndrome (ACS) have been proven to be great advances in the management of both traumatic and nontraumatic surgical conditions. The practice of damage control surgery includes 3 components: 1) abbreviated resuscitative surgery for rapid control of hemorrhage and abdominal contamination by gastrointestinal contents, followed by temporary abdominal wall closure for planned reoperation and prevention of ACS; 2) restoration of physiologic function, including rewarming and correction of coagulopathy and hemodynamic stabilization in the intensive care unit; and 3) re-exploration for the definitive management of injuries and abdominal wall closure...
December 2009: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Ramanath N Haricharan, Adam C Dooley, Jordan A Weinberg, Gerald McGwin, Paul A MacLennan, Russell L Griffin, Loring W Rue, Donald A Reiff
BACKGROUND: A growing body of literature demonstrates that irrespective of the mechanism of injury, obesity is associated with significantly worse morbidity and mortality after trauma. Among patients requiring damage control laparotomy (DCL), clinical experience suggests that obesity affects time to definitive closure though this association has never been demonstrated quantitatively. METHODS: All patients at an academic Level I trauma center requiring a DCL between January 2002 and December 2006 (N = 148) were included...
June 2009: Journal of Trauma
Richard J Fantus, Michele M Mellett, John P Kirby
Open management of the abdomen has become an accepted technique for both the treatment and the prevention of abdominal compartment syndrome. It has also gained popularity as a treatment option in situations requiring multiple laparotomies such as uncontrolled intra-abdominal infections and severe abdominal injury necessitating damage control surgery. A significant number of patients managed with the open abdomen technique are unable to undergo complete abdominal wall closure and consequently develop large, complex anterior abdominal wall hernias...
August 2006: American Journal of Surgery
John C Lee, Andrew B Peitzman
PURPOSE OF REVIEW: This article summarizes the current state of damage-control laparotomy as practiced in trauma surgery. Since the first description of deliberately abbreviated laparotomy 20 years ago, damage-control laparotomy has been widely applied. The purpose of this review is to discuss current concepts in damage-control laparotomy in trauma and general surgery patients. RECENT FINDINGS: The immediate, essential goals of control of surgical bleeding and containment of gastrointestinal soilage are achieved at a truncated laparotomy...
August 2006: Current Opinion in Critical Care
P J Offner, A L de Souza, E E Moore, W L Biffl, R J Franciose, J L Johnson, J M Burch
HYPOTHESIS: Abdominal compartment syndrome (ACS) is a morbid complication of damage-control laparotomy. Moreover, the technique of abdominal closure influences the frequency of ACS. DESIGN: Retrospective cohort study. SETTING: Urban level I trauma center. PATIENTS: We studied 52 patients with trauma who required damage-control laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours...
June 2001: Archives of Surgery
M L Walker
The damage control laparotomy is an advancement in the management of massively injured trauma victims. Mortality for this group of patients remains high but some can be saved using staged abdominal reconstruction for trauma. Massive liver injuries, pelvic trauma, and retroperitoneal injury are some of the indications for this approach. Careful replacement of blood and blood products along with correction of hypothermia and optimization of oxygen transport represents a critical phase in this management approach...
February 1995: Journal of the National Medical Association
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