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Is Barbed Better? Evaluation of Triclosan-Coated Barbed Suture on Wound Complications Following Emergency Laparotomy. 带刺缝合线更好吗?评估三氯生涂层带刺缝合线对急诊腹腔手术后伤口并发症的影响
Pub Date : 2024-04-10 DOI: 10.1097/ta.0000000000004341
Joshua Dilday, Patrick McGillen, Stephen Park, Shea Gallagher, Heewon Lee, Morgan Schellenberg, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin
Emergent laparotomy is associated with significant wound complications including surgical site infections (SSI) and fascial dehiscence (FD). Triclosan-coated barbed suture (TCB) for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications.
紧急开腹手术会导致严重的伤口并发症,包括手术部位感染(SSI)和筋膜开裂(FD)。用于筋膜缝合的三氯生涂层倒钩缝合线(TCB)已被证明可减少局部并发症,但主要是在择期手术中。我们试图评估 TCB 紧急开腹筋膜缝合对主要伤口并发症的影响。
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引用次数: 0
The Difficult Cholecystectomy: What You Need to Know. 疑难胆囊切除术:您需要了解的知识。
Pub Date : 2024-04-10 DOI: 10.1097/ta.0000000000004337
Anupamaa Seshadri, Andrew B Peitzman
This review discusses the grading of cholecystitis, the optimal timing of cholecystectomy, adopting a culture of safe cholecystectomy, understanding the common error traps that can lead to intraoperative complications and how to avoid them. The Tokyo Guidelines, AAST, Nassar and Parkland scoring systems are discussed. The patient factors, physiologic status and operative findings that predict a difficult cholecystectomy or conversion from laparoscopic to open cholecystectomy are reviewed. With laparoscopic expertise and patient conditions that are not prohibitive, early laparoscopic cholecystectomy is recommended. This is ideally within 72 hours of admission but supported up to the seventh hospital day. The majority of bile duct injuries (BDI) are due to misidentification of normal anatomy. Strasberg's four error traps and the zones of danger to avoid during a cholecystectomy are described. The review emphasizes the importance of a true critical view of safety (CVS) for identification of the anatomy. In up to 15% of operations for acute cholecystitis, a CVS cannot be achieved safely. Recognizing these conditions and changing your operative strategy are mandatory to avoid harm. The principles to follow for a safe cholecystectomy are discussed in detail. The cardinal message of this review is "under challenging conditions, BDI can be minimized via either a subtotal cholecystectomy or top-down cholecystectomy if dissection in the hepatocystic triangle is avoided." (28) The most severe biliary/vascular injuries usually occur after conversion from laparoscopic cholecystectomy. Indications and techniques for bailout procedures including the fenestrating and reconstituting subtotal cholecystectomy are presented. Seven to ten percent of cholecystectomies for acute cholecystitis currently result in subtotal cholecystectomy.
本综述讨论了胆囊炎的分级、胆囊切除术的最佳时机、采用安全胆囊切除术的文化、了解可导致术中并发症的常见错误陷阱以及如何避免这些错误。讨论了东京指南、AAST、Nassar 和 Parkland 评分系统。回顾了预测胆囊切除术困难或从腹腔镜胆囊切除术转为开腹胆囊切除术的患者因素、生理状态和手术结果。在腹腔镜专业技术和患者条件允许的情况下,建议尽早进行腹腔镜胆囊切除术。腹腔镜胆囊切除术最好在患者入院后 72 小时内进行,但也支持在住院第七天内进行。大多数胆管损伤 (BDI) 都是由于对正常解剖结构的错误识别造成的。文中介绍了 Strasberg 的四个错误陷阱和胆囊切除术中应避免的危险区域。评论强调了真正的安全关键视图(CVS)对于识别解剖结构的重要性。在多达 15% 的急性胆囊炎手术中,无法安全地进行 CVS。认识到这些情况并改变手术策略是避免伤害的必要条件。本文详细讨论了安全胆囊切除术应遵循的原则。本综述的主要信息是 "在具有挑战性的条件下,如果避免在肝囊肿三角区进行解剖,可以通过胆囊次全切除术或自上而下胆囊切除术将 BDI 降到最低"。(28)最严重的胆道/血管损伤通常发生在腹腔镜胆囊切除术后。本文介绍了保胆手术的适应症和技术,包括胆囊切除术和重组胆囊次全切除术。目前,在急性胆囊炎的胆囊切除术中,有 7% 到 10% 的胆囊切除术是次全胆囊切除术。
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引用次数: 0
Warfarin, not direct oral anticoagulants nor antiplatelet therapy, is associated with increased bleeding risk in emergency general surgery patients: implications in this new era of novel anticoagulants: An EAST Multicenter study. 华法林(而非直接口服抗凝剂或抗血小板疗法)与急诊普外科患者出血风险增加有关:新型抗凝剂新时代的意义:EAST 多中心研究。
Pub Date : 2024-04-10 DOI: 10.1097/ta.0000000000004278
Seema P Anandalwar, Lindsay O'Meara, Roumen Vesselinov, Ashling Zhang, Jeffrey N Baum, Amanda Cooper, Cassandra Decker, Thomas Schroeppel, Jenny Cai, Daniel Cullinane, Richard D Catalano, Nikolay Bugaev, Madison LeClair, Christina Feather, Katherine McBride, Valerie Sams, Pak Shan Leung, Samantha Olafson, Devon S Callahan, Joseph Posluszny, Simon Moradian, Jordan Estroff, Beth Hochman, Natasha Coleman, Anna Goldenberg-Sandau, Jeffry Nahmias, Kathryn Rosenbaum, Jason Pasley, Lindsay Boll, Leah Hustad, Jessica Reynolds, Michael Truitt, Mira Ghneim
To assess perioperative bleeding complications & in-hospital mortality in patients requiring emergency general surgery (EGS) presenting with a history of antiplatelet (AP) vs. direct oral anticoagulant (DOAC) vs warfarin use.
评估有抗血小板(AP)与直接口服抗凝剂(DOAC)与华法林使用史的急诊普外科(EGS)患者的围手术期出血并发症&;院内死亡率。
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引用次数: 0
Plasma Proteomics Profile-Based Comparison of Torso Versus Brain Injury: A Prospective Cohort Study. 基于血浆蛋白质组学特征的躯干与脑损伤比较:前瞻性队列研究
Pub Date : 2024-04-10 DOI: 10.1097/ta.0000000000004356
Jotaro Tachino, Yuki Togami, Hisatake Matsumoto, Tsunehiro Matsubara, Shigeto Seno, Hiroshi Ogura, Jun Oda
Trauma-related deaths and post-traumatic sequelae are a global health concern, necessitating a deeper understanding of the pathophysiology to advance trauma therapy. Proteomics offers insights into identifying and analyzing plasma proteins associated with trauma and inflammatory conditions; however, current proteomic methods have limitations in accurately measuring low-abundance plasma proteins. This study compared plasma proteomics profiles of patients from different acute trauma subgroups to identify new therapeutic targets and devise better strategies for personalized medicine.
与创伤相关的死亡和创伤后遗症是全球关注的健康问题,因此有必要加深对病理生理学的了解,以推进创伤治疗。蛋白质组学为识别和分析与创伤和炎症相关的血浆蛋白质提供了见解;然而,目前的蛋白质组学方法在准确测量低丰度血浆蛋白质方面存在局限性。本研究比较了不同急性创伤亚组患者的血浆蛋白质组学特征,以确定新的治疗目标,为个性化医疗制定更好的策略。
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引用次数: 0
Investigation and Validation of the TEG6s During Rotary Wing Aeromedical Flight. 在旋转翼航空医疗飞行中对 TEG6 进行调查和验证。
Pub Date : 2024-04-08 DOI: 10.1097/ta.0000000000004335
James Bardes, Daniel Grabo, Aaron Shmookler, Sijin Wen, Alison Wilson
In order to improve rural and austere trauma care, hospital-based testing performed at the point of injury may shorten the time lapsed from injury to intervention. This study aimed to evaluate the use of the TEG6s® device in a rotary wing aircraft. Prior attempts suffered from limitation related to lack of vibration mitigation.
为了改善农村和艰苦地区的创伤护理,在受伤地点进行医院检测可缩短从受伤到进行干预的时间。本研究旨在评估 TEG6s® 设备在旋翼飞机上的使用情况。之前的尝试因缺乏减震措施而受到限制。
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引用次数: 0
Impact of hypocalcemia on mortality in pediatric trauma patients who require transfusion. 低钙血症对需要输血的儿科创伤患者死亡率的影响。
Pub Date : 2024-04-08 DOI: 10.1097/ta.0000000000004330
Elissa Abou Khalil, Erin Feeney, Katrina M Morgan, Philip C Spinella, Barbara A Gaines, Christine M Leeper
Admission hypocalcemia has been associated with poor outcomes in injured adults. The impact of hypocalcemia on mortality has not been widely studied in pediatric trauma.
入院时的低钙血症与成人伤者的不良预后有关。低钙血症对儿科创伤死亡率的影响尚未得到广泛研究。
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引用次数: 0
I Would Not Change a Thing! 我不会改变任何事情!
Pub Date : 2024-04-08 DOI: 10.1097/TA.0000000000004350
Amy J Goldberg
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引用次数: 0
Irregular Warfare Must Combine Good Medicine, with Both Good Tactics and Good Strategies: Position Paper by the French Special Operations Forces Medical Command. 非正规战争必须将良好的医疗与良好的战术和战略相结合:法国特种作战部队医疗指挥部的立场文件。
Pub Date : 2024-04-01 DOI: 10.1097/ta.0000000000004336
Pierre Pasquier, Mathieu David, Ludovic Petit, Morgan Chery, Sébastien Habas, Edouard Patey, Sébastien Conort, Nicolas Zeller, Marc-Olivier Gelmann, Sébastien Peyrefitte, Fabrice Castel, Stéphane Travers, Pierre Mahé
Military operations are no longer limited to the application of counterterrorism and counterinsurgency strategies; they are now characterized by hybrid, irregular, and unconventional features. While some authors have indicated the need for medical support to adapt to these new modes of military operations, they have focused mainly on the tactical level of care on the battlefield. As Sun Tzu states, "Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat," further proposals are still needed on the application of both medical tactics and medical strategies in irregular warfare.
军事行动不再局限于反恐和反叛乱战略的应用;现在的军事行动具有混合、非正规和非常规的特点。虽然一些作者指出医疗支持需要适应这些新的军事行动模式,但他们主要关注的是战场上战术层面的护理。正如孙子所说:"没有战术的战略是通向胜利的最缓慢的道路。没有战略的战术是失败前的喧闹",因此仍需就非正规战争中医疗战术和医疗战略的应用提出进一步建议。
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引用次数: 0
Performance of three predictive scores to avoid delayed diagnosis of significant blunt bowel and mesenteric injury. A 12-year retrospective cohort study. 避免重大钝性肠道和肠系膜损伤延迟诊断的三个预测性评分。一项为期12年的回顾性队列研究。
Pub Date : 2023-12-19 DOI: 10.1097/ta.0000000000004231
Fabio Agri, Basile Pache, Mylène Bourgeat, Vincent Darioli, Nicolas Demartines, Sabine Schmidt, Tobias Zingg
Avoiding missed diagnosis and therapeutic delay for significant blunt bowel and mesenteric injuries (sBBMI) after trauma is still challenging despite the widespread use of computed tomography. Several scoring tools aiming at reducing this risk have been published. The purpose of the present work was to assess the incidence of delayed (>24 h) diagnosis for sBBMI patients and to compare the predictive performance of three previously published scores using clinical, radiological and laboratory findings: the "Bowel Injury Prediction Score" (BIPS) and the scores developed by Raharimanantsoa (RS) and by Faget (FS).
尽管计算机断层扫描已得到广泛应用,但避免创伤后重大钝性肠道和肠系膜损伤(sBBMI)的漏诊和治疗延误仍是一项挑战。目前已发布了几种旨在降低这一风险的评分工具。本研究的目的是评估sBBMI患者延迟(24小时)诊断的发生率,并比较之前发表的三种使用临床、放射学和实验室检查结果的评分方法:"肠损伤预测评分"(BIPS)以及Raharimanantsoa(RS)和Faget(FS)开发的评分方法。
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引用次数: 0
Antibiotic prophylaxis in trauma: GAIS, SIS-E, WSIS, AAST, WSES guidelines. 创伤中的抗生素预防:GAIS、SIS-E、WSIS、AAST、WSES 指南。
Pub Date : 2023-12-18 DOI: 10.1097/ta.0000000000004233
Federico Coccolini, Massimo Sartelli, Robert Sawyer, Kemal Rasa, Marco Ceresoli, Bruno Viaggi, Fausto Catena, Dimitrios Damaskos, Enrico Cicuttin, Camilla Cremonini, Ernest E Moore, Walter L Biffl, Raul Coimbra
Trauma is a complex disease, and the use of antibiotic prophylaxis (AP) in trauma patients is common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. Antibiotic stewardship is of paramount importance in fighting resistance spread. Definitive rules or precise indications about antibiotic prophylaxis in trauma remain unclear. The present manuscript describes the indications of antibiotic prophylaxis in traumatic lesions to the head, brain, torso, maxillo-facial, extremities, skin, and soft tissues endorsed by the Global Alliance for Infection in Surgery (GAIS), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), World Society of Emergency Surgery (WSES).
创伤是一种复杂的疾病,在创伤患者中使用抗生素预防(AP)是常见的做法。然而,考虑到抗生素耐药性的增加,抗生素的使用应受到质疑,并仅限于特定病例。抗生素管理对于防止耐药性扩散至关重要。有关创伤中抗生素预防的明确规则或确切指征仍不清楚。本手稿介绍了全球外科感染联盟(GAIS)、欧洲外科感染学会(SIS-E)、世界外科感染学会(WSIS)、美国创伤外科学会(AAST)和世界急诊外科学会(WSES)认可的头部、脑部、躯干、颌面部、四肢、皮肤和软组织创伤性病变的抗生素预防指征。
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The Journal of Trauma and Acute Care Surgery
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