Nearly 9% of men and 30% of women in the United States experience symptoms or complications of gallstone disease. As such, nearly every general surgeon in the country encounters patients with this pathology numerous times during his or her career. Cholelithiasis can cause complications such as acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and the rare entities of Mirizzi syndrome and gallstone ileus. Patients with gallstones have a 1 to 3% risk per year of a complication, and that risk increases significantly to 30% in those with biliary colic. Surgical management of the complications of gallstones is especially intriguing because the cases are often perceived as low complexity; however, it is an operation that can challenge even the most seasoned attending and result in significant complications. Studies demonstrate complication rates up to 10% following cholecystectomy, with bile duct injury rates hovering at 4 in 1,000. This chapter aims to provide the reader with knowledge of the presentation, imaging, work-up, and framework for the management of complicate gallbladder disease. Furthermore, we hope to provide you with a foundation of how to perform a safe cholecystectomy in a variety of circumstances and impart a few tips and tricks for some challenging intraoperative situations. This review contains 2 figures, and 55 references. Key Words: cholecystitis, choledocholithiasis, cholescintigraphy, common bile duct exploration, critical view of safety, ERCP, gallstone pancreatitis, subtotal cholecystectomy
{"title":"Management of Complicated Gallstone Disease","authors":"G. Wakam, D. Telem","doi":"10.2310/surg.2065","DOIUrl":"https://doi.org/10.2310/surg.2065","url":null,"abstract":"Nearly 9% of men and 30% of women in the United States experience symptoms or complications of gallstone disease. As such, nearly every general surgeon in the country encounters patients with this pathology numerous times during his or her career. Cholelithiasis can cause complications such as acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and the rare entities of Mirizzi syndrome and gallstone ileus. Patients with gallstones have a 1 to 3% risk per year of a complication, and that risk increases significantly to 30% in those with biliary colic. Surgical management of the complications of gallstones is especially intriguing because the cases are often perceived as low complexity; however, it is an operation that can challenge even the most seasoned attending and result in significant complications. Studies demonstrate complication rates up to 10% following cholecystectomy, with bile duct injury rates hovering at 4 in 1,000. This chapter aims to provide the reader with knowledge of the presentation, imaging, work-up, and framework for the management of complicate gallbladder disease. Furthermore, we hope to provide you with a foundation of how to perform a safe cholecystectomy in a variety of circumstances and impart a few tips and tricks for some challenging intraoperative situations.\u0000\u0000This review contains 2 figures, and 55 references.\u0000Key Words: cholecystitis, choledocholithiasis, cholescintigraphy, common bile duct exploration, critical view of safety, ERCP, gallstone pancreatitis, subtotal cholecystectomy","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"2836 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86505650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biliary tract tumors are derived from the underlying intrahepatic or extrahepatic biliary epithelium. Molecular analysis of the biliary neoplasms suggests a stepwise tumor progression from benign to malignant lesions. Treatment of these tumors remains complex and requires a careful clinical evaluation. Revisions of staging systems allow for appropriate evaluation of the extent of the malignancy. Refined surgical techniques and advances in adjuvant therapies provide improved treatment options. Despite these efforts, the prognosis remains poor. This chapter discusses several different types of biliary tumors, including the gallbladder carcinoma, and examines the underlying etiologies, clinical presentation, diagnostic studies, staging, treatment, and prognosis. The staging of the malignant lesions is updated to reflect the American Joint Committee on Cancer’s eighth edition system. This review contains 7 figures, 5 tables, and 77 references. Key Words: α-fetoprotein, American Joint Committee on Cancer, biliary intraepithelial neoplasia, Bismuth-Corlette, CA19-9, cystadenoma, endoscopic retrograde cholangiopancreatography, intraductal papillary neoplasm of the bile duct, Magnetic resonance cholangiopancreatography, primary sclerosing cholangitis, percutaneous transhepatic cholangiography
{"title":"Tumors of the Biliary Tract","authors":"A. Kim, H. Nathan","doi":"10.2310/surg.2374","DOIUrl":"https://doi.org/10.2310/surg.2374","url":null,"abstract":"Biliary tract tumors are derived from the underlying intrahepatic or extrahepatic biliary epithelium. Molecular analysis of the biliary neoplasms suggests a stepwise tumor progression from benign to malignant lesions. Treatment of these tumors remains complex and requires a careful clinical evaluation. Revisions of staging systems allow for appropriate evaluation of the extent of the malignancy. Refined surgical techniques and advances in adjuvant therapies provide improved treatment options. Despite these efforts, the prognosis remains poor. This chapter discusses several different types of biliary tumors, including the gallbladder carcinoma, and examines the underlying etiologies, clinical presentation, diagnostic studies, staging, treatment, and prognosis. The staging of the malignant lesions is updated to reflect the American Joint Committee on Cancer’s eighth edition system.\u0000This review contains 7 figures, 5 tables, and 77 references.\u0000Key Words: α-fetoprotein, American Joint Committee on Cancer, biliary intraepithelial neoplasia, Bismuth-Corlette, CA19-9, cystadenoma, endoscopic retrograde cholangiopancreatography, intraductal papillary neoplasm of the bile duct, Magnetic resonance cholangiopancreatography, primary sclerosing cholangitis, percutaneous transhepatic cholangiography","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83574110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Continued hepatic injury by genetic or environmental factors results in a state of chronic inflammation, fibrosis, and progressive hepatocyte dysfunction that can progress to cirrhosis and end stage liver disease (ESLD). Cirrhosis is the eighth leading cause of mortality in the United States, while the burden of disease is even greater in regions with endemic viral hepatitis. Common risk factors include a history of hepatitis; alcohol or IV drug abuse; use of certain medications; and other risk factors associated with transmission of viral hepatitis, including tattoos, sexual promiscuity, and incarceration. Although many patients with cirrhosis are asymptomatic and remain undiagnosed, many will eventually develop secondary complications from chronic liver failure, which can be difficult to manage and are associated with significant morbidity, including: portal hypertension, variceal bleeding, coagulopathy, hepatic encephalopathy, and renal failure. In addition, hepatocellular carcinoma (HCC) is estimated to be 30 times more common among patients with cirrhosis, which can be an aggressive malignancy with 5-year overall survival of less than 15%. In this chapter, we provide a comprehensive overview of chronic liver failure, including the epidemiology of cirrhosis, pathophysiology of liver injury, and assessment and management of cirrhosis and associated downstream complications. Finally, we discuss the role of liver transplantation for both ESLD and HCC. This review contains 6 figures, 9 tables, and 53 references. Key Words: chronic liver failure, cirrhosis, coagulopathy, end stage liver disease, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, liver transplantation, portal hypertension, varices
{"title":"Chronic Hepatic Failure","authors":"Derek J. Erstad, M. Qadan","doi":"10.2310/surg.2413","DOIUrl":"https://doi.org/10.2310/surg.2413","url":null,"abstract":"Continued hepatic injury by genetic or environmental factors results in a state of chronic inflammation, fibrosis, and progressive hepatocyte dysfunction that can progress to cirrhosis and end stage liver disease (ESLD). Cirrhosis is the eighth leading cause of mortality in the United States, while the burden of disease is even greater in regions with endemic viral hepatitis. Common risk factors include a history of hepatitis; alcohol or IV drug abuse; use of certain medications; and other risk factors associated with transmission of viral hepatitis, including tattoos, sexual promiscuity, and incarceration. Although many patients with cirrhosis are asymptomatic and remain undiagnosed, many will eventually develop secondary complications from chronic liver failure, which can be difficult to manage and are associated with significant morbidity, including: portal hypertension, variceal bleeding, coagulopathy, hepatic encephalopathy, and renal failure. In addition, hepatocellular carcinoma (HCC) is estimated to be 30 times more common among patients with cirrhosis, which can be an aggressive malignancy with 5-year overall survival of less than 15%. In this chapter, we provide a comprehensive overview of chronic liver failure, including the epidemiology of cirrhosis, pathophysiology of liver injury, and assessment and management of cirrhosis and associated downstream complications. Finally, we discuss the role of liver transplantation for both ESLD and HCC.\u0000This review contains 6 figures, 9 tables, and 53 references.\u0000Key Words: chronic liver failure, cirrhosis, coagulopathy, end stage liver disease, hepatic encephalopathy, hepatocellular carcinoma, hepatorenal syndrome, liver transplantation, portal hypertension, varices","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87842022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. This review contains 12 figures, 6 tables, 1 video, and 74 references. Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging
{"title":"Breast Augmentation","authors":"E. Culbertson, William P. Adams Jr","doi":"10.2310/ps.10086","DOIUrl":"https://doi.org/10.2310/ps.10086","url":null,"abstract":"Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery. \u0000This review contains 12 figures, 6 tables, 1 video, and 74 references.\u0000Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging ","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75021018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation. This review contains 7 figures and 29 references. Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction
{"title":"Midface Reconstruction","authors":"William J Rifkin, J. Diaz-Siso, E. Rodriguez","doi":"10.2310/ps.10065","DOIUrl":"https://doi.org/10.2310/ps.10065","url":null,"abstract":"Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation.\u0000 \u0000This review contains 7 figures and 29 references.\u0000Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82053184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis. This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis
{"title":"Surgical Treatment of Diverticulitis","authors":"Tiffany K. Weidner, John Kidwell, D. Etzioni","doi":"10.2310/surg.2393","DOIUrl":"https://doi.org/10.2310/surg.2393","url":null,"abstract":"Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis.\u0000 This review contains 8 figures, 4 tables, and 67 references.\u0000Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80849987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diverticulitis in certain subpopulations of patients may require different treatments, especially in the elective setting. Diverticular bleeding, another complication of diverticulosis, is another source of burden on United States healthcare from diverticular disease. This chapter discusses the special circumstances of right-sided diverticulitis, diverticulitis in young patients or immunocompromised patients, recurrent diverticulitis after resection, giant colonic diverticulum, and rare presentations of diverticulitis. Atypical types of diverticulitis such as segmental colitis associated with diverticulosis (SCAD), symptomatic uncomplicated diverticular disease (SUDD), and smoldering diverticulitis are also reviewed, and indications for surgical intervention are summarized. Current controversies are reviewed, including the decision to operate in young or immunocompromised patients; management of SCAD, SUDD, or smoldering diverticulitis; and best localization method to diagnose diverticular bleeding. This review contains 6 figures, 2 tables, and 55 references. Key Words: atypical diverticulitis, diverticular bleeding, diverticular disease, diverticulosis, gastrointestinal bleeding, right-sided diverticulitis, segmental colitis associated with diverticulosis, smoldering diverticulitis, symptomatic uncomplicated diverticular disease, total abdominal colectomy
{"title":"Special Considerations of Diverticulitis and Diverticular Bleeding","authors":"Tiffany K. Weidner, John Kidwell, D. Etzioni","doi":"10.2310/surg.2392","DOIUrl":"https://doi.org/10.2310/surg.2392","url":null,"abstract":"Diverticulitis in certain subpopulations of patients may require different treatments, especially in the elective setting. Diverticular bleeding, another complication of diverticulosis, is another source of burden on United States healthcare from diverticular disease. This chapter discusses the special circumstances of right-sided diverticulitis, diverticulitis in young patients or immunocompromised patients, recurrent diverticulitis after resection, giant colonic diverticulum, and rare presentations of diverticulitis. Atypical types of diverticulitis such as segmental colitis associated with diverticulosis (SCAD), symptomatic uncomplicated diverticular disease (SUDD), and smoldering diverticulitis are also reviewed, and indications for surgical intervention are summarized. Current controversies are reviewed, including the decision to operate in young or immunocompromised patients; management of SCAD, SUDD, or smoldering diverticulitis; and best localization method to diagnose diverticular bleeding.\u0000This review contains 6 figures, 2 tables, and 55 references.\u0000Key Words: atypical diverticulitis, diverticular bleeding, diverticular disease, diverticulosis, gastrointestinal bleeding, right-sided diverticulitis, segmental colitis associated with diverticulosis, smoldering diverticulitis, symptomatic uncomplicated diverticular disease, total abdominal colectomy","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76851036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed. This review contains 10 figures, 3 tables, and 67 references. keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis
{"title":"Diagnosis and Management of Acute Diverticulitis","authors":"Tiffany K. Weidner, John Kidwell, D. Etzioni","doi":"10.2310/surg.2391","DOIUrl":"https://doi.org/10.2310/surg.2391","url":null,"abstract":"Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed.\u0000 This review contains 10 figures, 3 tables, and 67 references.\u0000keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"2015 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86973059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The geriatric trauma population continues to grow as life expectancy and unintentional injury increase. Age-related physiologic changes and complex comorbidities may not only lead to injury but also may precipitate a downward spiral. The injury patterns, presentation of life-threatening injury, and response to injury are unique in the elderly trauma population, and dedicated evaluation of elderly trauma patients at a trauma center may be beneficial. Aggressive, early intervention with a focus on geriatric-specific needs and care coordination are an integral part of the management to reduce morbidity and mortality. Much of the unintentional injuries may be preventable with identification of risk factors for falls and fall prevention programs. Frailty measurements may be used to predict morbidity and functional status. Surgeons must become familiar with geriatric-specific issues and how best to treat the geriatric trauma population. This review contains 3 figures, 2 tables, and 133 references. Key Words: care coordination, elderly, frailty, geriatric, injury, prevention, risk factors, trauma, triage
{"title":"Geriatric Trauma","authors":"Sigrid Burruss, Lillian C. Min, A. Tillou","doi":"10.2310/surg.2254","DOIUrl":"https://doi.org/10.2310/surg.2254","url":null,"abstract":"The geriatric trauma population continues to grow as life expectancy and unintentional injury increase. Age-related physiologic changes and complex comorbidities may not only lead to injury but also may precipitate a downward spiral. The injury patterns, presentation of life-threatening injury, and response to injury are unique in the elderly trauma population, and dedicated evaluation of elderly trauma patients at a trauma center may be beneficial. Aggressive, early intervention with a focus on geriatric-specific needs and care coordination are an integral part of the management to reduce morbidity and mortality. Much of the unintentional injuries may be preventable with identification of risk factors for falls and fall prevention programs. Frailty measurements may be used to predict morbidity and functional status. Surgeons must become familiar with geriatric-specific issues and how best to treat the geriatric trauma population.\u0000 This review contains 3 figures, 2 tables, and 133 references.\u0000Key Words: care coordination, elderly, frailty, geriatric, injury, prevention, risk factors, trauma, triage","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73241556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references. Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation
{"title":"Operative Exposure of Abdominal Injuries and Closure of the Abdomen","authors":"Matthew D. Nealeigh, M. Bowyer","doi":"10.2310/surg.2134","DOIUrl":"https://doi.org/10.2310/surg.2134","url":null,"abstract":"Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text.\u0000This review contains 7 figures, 2 tables, and 41 references. \u0000Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation","PeriodicalId":11151,"journal":{"name":"DeckerMed Plastic Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81985906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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