Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

Background: Craniofacial nerve injuries are a major source of long-term morbidity following maxillofacial trauma, often resulting in substantial functional impairment and psychosocial burden. This study aimed to perform a trauma-focused bibliometric analysis of the evolving research landscape on craniofacial nerve injuries and to determine whether the literature reflects a shift from trauma-related injury mechanisms toward surgically modifiable risk factors.

Methods: A bibliometric analysis was conducted using publications indexed in the Web of Science (WoS) Core Collection and Scopus databases. Articles and reviews were retrieved using predefined trauma-related search terms. The search identified 119 records in WoS and 449 records in Scopus. Following database integration, duplicate removal, and PRISMA-guided (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) screening, 118 publications were included in the final analysis. Bibliographic data were evaluated to characterize thematic distribution, temporal trends, and comparative patterns among facial, inferior alveolar, and lingual nerve injuries. Keyword-based thematic clustering was used to identify major research domains.

Results: Three principal trauma-related anatomical clusters were identified: facial nerve, inferior alveolar nerve, and lingual nerve injuries. Facial nerve injury emerged as the dominant research theme and was primarily associated with risks related to surgical approaches and operative management. Inferior alveolar nerve injury was more commonly linked to mandibular fracture patterns and fixation-related complications, whereas lingual nerve injury, although less frequently studied, demonstrated a disproportionately high functional impact. Temporal analysis revealed a gradual shift in research emphasis from fracture-driven inferior alveolar nerve injury toward facial nerve injury as a surgically modifiable risk factor.

Conclusion: The findings demonstrate a clear evolution in craniofacial nerve injury research, highlighting the growing importance of anatomical knowledge and surgical decision-making in optimizing long-term neurological and functional outcomes following maxillofacial trauma.

Round: This study aimed to evaluate the effects of silibinin, a compound with demonstrated therapeutic effects in various liver diseases, on liver healing in a rat model of blunt liver trauma.

Methods: Twenty-four Wistar albino rats weighing 250-300 g were randomly assigned to three equal groups. Group I served as the control group (CG) and received standard nutrition without trauma induction. Under general anesthesia, rats in Groups II and III underwent a blunt trauma procedure applied to the right upper abdominal quadrant. Group II, designated as the trauma group (TG), received standard nutrition only. Group III, designated as the trauma-silibinin group (T-SG), received silibinin at a dose of 100 mg/kg/day via gastric gavage for five days in addition to standard nutrition. Following the five-day observation period, blood samples were collected from inferior vena cava. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured in the collected blood specimens. Histopathological examination of liver tissue was performed to assess the degree of inflammation.

Results: Mean AST and ALT levels differed significantly among the groups (p<0.001). Although no statistically significant difference was observed in inflammation scores between the TG and T-SG groups (p=0.115), inflammation scores tended to be higher in the TG, with a moderate effect size (r=0.41). Furthermore, the risk of a high injury score was 11.7 times greater in the TG than in the T-SG.

Conclusion: To our knowledge, this is the priority study to evaluate the effects of silibinin in a rat model of blunt liver trauma. Silibinin may represent a promising therapeutic agent for reducing inflammation following liver trauma and promoting liver healing.

Background: The timing of extubation after general anesthesia (GA) in patients with acute ischemic stroke treated with mechanical thrombectomy (MT) is a significant issue. Prolonged duration of mechanical ventilation is considered to be an independent risk factor that negatively affects functional survival in patients receiving neurocritical care. This study evaluated the effect of time to extubation and the development of pneumonia on clinical prognosis after MT performed under GA.

Methods: This retrospective, single-center, observational study included patients ≥18 years of age who underwent MT under GA for acute ischemic stroke between January 2023 and May 2025. Patient data were retrospectively obtained from hospital records and supplemented, when necessary, with information from patients' relatives. Demographic data, lengths of intensive care unit and hospital stay, additional complications, neurological functional status (modified Rankin Scale [mRS]) at discharge, and mortality were examined. Patients were evaluated according to extubation timing, pneumonia, discharge mRS score (0-2, favorable; 3-6, unfavorable), and 30-day mortality using multivariate logistic regression analysis.

Results: Data from 119 patients (mean age, 70.3±13.6 years) were analyzed. Patients in whom time to extubation was >24 h were older (p=0.003), exhibited a lower pre-procedural Glasgow Coma Scale (GCS) score (p<0.001), and higher pneumonia and mortality rates (p<0.001). Logistic regression analyses revealed that time to extubation >24 h significantly increased the likelihood of an unfavorable mRS score and mortality (p<0.001). Lower pre-procedural GCS (odds ratio [OR] 0.64; p<0.001) and higher American Society of Anesthesiologists Physical Status (ASA-PS) classification (OR 27.966; p<0.002) scores significantly affected time to extubation. A high ASA-PS score was found to increase the probability of pneumonia by tenfold (95% confidence interval 1.1-100.9). Patients with pneumonia exhibited significantly higher mRS scores (p<0.001).

Conclusion: Although the time to extubation had a significant impact on poor neurological prognosis and mortality in patients undergoing MT for acute stroke, the development of pneumonia appeared to be associated with unfavorable early neurological functional outcomes.

Background: Major abdominal surgery is associated with a high incidence of postoperative complications, morbidity, and mortality. The Systemic Immune-Inflammation Index (SII), calculated from neutrophil, platelet, and lymphocyte counts, reflects both inflammatory and immune status and has been shown to predict outcomes in various diseases. This study aimed to retrospectively evaluate the outcomes of patients admitted to the intensive care unit (ICU) after urgent or elective major abdominal surgery and to investigate the association between postoperative SII and ICU mortality.

Methods: We retrospectively analyzed patients admitted to the surgical ICU after major abdominal surgery between November 2022 and November 2023. Patients who died within the first 24 hours of ICU admission, were admitted to the ICU for less than 48 hours, and were younger than 18 years were excluded.

Results: During the study period, 360 patients were admitted to the surgical ICU, of whom 102 underwent major abdominal surgery. One patient was excluded because of death within the first 24 hours of ICU admission, leaving 101 patients for analysis. Fifty-nine patients (58.4%) were women, and the mean age was 70.1±15.2 years. Urgent abdominal surgery was performed in 42 patients (41.6%). ICU mortality was higher among patients who underwent urgent surgery (23.8%) than among those who underwent elective surgery (5.1%) (p=0.013). Receiver operating characteristic (ROC) curve analysis identified a postoperative SII cutoff value of 998.26. A low postoperative SII was independently associated with mortality after major abdominal surgery, with a sensitivity of 82.9% and a specificity of 69.2% (95% confidence interval: 0.0579-0.913, p=0.004).

Conclusion: Postoperative SII may be a useful prognostic marker for predicting clinical outcomes and mortality in patients undergoing major abdominal surgery.

Background: This study aimed to evaluate patients who presented to the emergency department with non-traumatic back or lumbar pain, without new-onset neurological deficits or cauda equina syndrome. Because of inadequate response to medical treatment, patients underwent imaging of the affected region and subsequently required emergency neurosurgical intervention.

Methods: We included patients aged ≥18 years who presented to the emergency department with back or lumbar pain, experienced no pain relief despite analgesic treatment, underwent imaging of the affected region, and were referred for emergency surgical treatment by the neurosurgery department based on imaging findings. Patients presenting with trauma, new-onset neurological defi-cits, or a history of prior spinal surgery were excluded.

Results: The study included 35 patients with a mean age of 65.51 years (range: 42-82). Among them, 11.4% (n=4) had chronic kidney disease, 37.14% (n=13) had diabetes mellitus, 22.8% (n=8) had a history of cancer, and 22.8% (n=8) had a family history of cancer. No red flag findings other than cancer-related risk factors were identified. The primary clinical indicator of underlying pathology was persistent pain despite analgesic treatment. Advanced diagnostic evaluation revealed pathological fractures in 77.1% of patients (n=27), spinal abscesses in 14.2% (n=5), and spondylodiscitis in 8.5% (n=3); all patients underwent emergency surgical treatment. Among patients with pathological fractures, histopathological examination demonstrated osteoporotic fractures in 59.2% (n=16) and metastatic fractures in 40.8% (n=11). Notably, all spinal metastases led to the initial diagnosis of cancer, and only two of these patients presented with red flag symptoms.

Conclusion: Patients without spinal emergencies or red flag symptoms may still require emergency surgical intervention. Therefore, diagnostic and evaluation algorithms should be developed for this patient population. We believe that pain severity scores may play an important role in such algorithms.

Background: This study aimed to compare the diagnostic performance of inflammatory biomarkers derived from routine blood parameters in patients with acute cholecystitis, based on the hypothesis that these biomarkers can predict gangrenous cholecystitis independently of imaging before surgery.

Methods: Data from 187 consecutive adult patients who underwent laparoscopic cholecystectomy for acute cholecystitis during the same hospitalization were retrospectively analyzed in an observational cohort. After the exclusion of 7 cases, 180 patients constituted the analytic cohort. Gangrenous cholecystitis was defined as intraoperative or pathological verification. C-reactive protein (CRP) and six prespecified haemogram-derived indices - the neutrophil-, platelet- and monocyte-to-lymphocyte ratios (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], monocyte-to-lymphocyte ratio [MLR]) and three composite indices (systemic immune-inflammation index, systemic inflammation response index [SIRI], aggregate index of systemic inflammation) - were evaluated; diagnostic accuracy was assessed using receiver operating characteristic-area under the curve (ROC-AUC), cutoff points were determined using the Youden index, and an age- and sex-adjusted logistic regression model was established.

Results: Gangrenous cholecystitis was confirmed in 33 of the 180 analyzed patients (18.3%). CRP was 163.00 mg/L (interquartile range [IQR] 39.00-224.00) in the gangrenous group and 15.00 mg/L (IQR 4.02-55.89) in the non-gangrenous group. Among hemogram-derived indices, SIRI (7.10 [4.09-10.03] vs. 2.48 [1.03-4.89]) and MLR (0.62 [0.40-0.79] vs. 0.31 [0.19-0.50]) were significantly higher in gangrenous cases (both p<0.001); NLR was 8.00 (5.32-12.90) vs. 4.00 (2.35-6.66) (p<0.001). In the ROC analysis, CRP showed the highest discriminatory power (AUC 0.81; 95% confidence interval 0.71-0.89); at a cutoff point of 61.0 mg/L, the sensitivity and specificity were 0.73 and 0.78, respectively. Among the derived indices, the highest AUCs were observed for SIRI and AISI. In the model including CRP and SIRI adjusted for age and sex, only CRP remained an independent predictor; each 10 mg/L increase in CRP was associated with a 14% increase in the odds of gangrenous cholecystitis.

Conclusion: CRP provides the highest discrimination for pre-operative prediction of gangrenous cholecystitis and was the only independent predictor in multivariable analysis. The hemogram-derived indices showed moderate univariable discrimination, but their additional value beyond CRP remains uncertain and requires further evaluation in larger, prospective cohorts.

Background: This study aimed to evaluate the diagnostic approaches, treatment modalities, and clinical outcomes of patients presenting to the emergency department following razor blade ingestion.

Methods: Hospital records of patients who presented to the emergency department with razor blade ingestion and were referred to the General Surgery Clinic between 2021 and 2024 were retrospectively reviewed. Data collected included demographics, presenting symptoms, time to presentation, number of ingested razor blades, imaging findings, treatment approaches, complications, and clinical outcomes.

Results: A total of 72 patients with complete medical records were included. All patients were male and incarcerated. The mean age was 31.2 years, and the mean time to presentation was 8 hours. The mean number of ingested razor blades was 1.4. Endoscopic intervention was performed in seven patients (10%) in whom imaging localized the razor blade to the stomach; all presented within 6 hours of ingestion. Successful endoscopic removal was achieved in two patients, while no razor blade was visualized in the stomach in five patients. Surgical intervention was required in two patients (3%). A total of 63 patients (87%) recovered without intervention with outpatient conservative management and follow-up. Successful endoscopic removal was achieved in patients who presented within the first 2 hours. No morbidity or mortality was observed.

Conclusion: A conservative management is safe and effective in most cases of razor blade ingestion. Early endoscopy may decrease the likelihood of surgical intervention.

Background: Adhesive small bowel obstruction (ASBO) remains a common surgical emergency, yet distinguishing patients who will fail conservative management continues to be difficult. Although many clinical and radiologic predictors have been proposed, their accuracy is inconsistent, and simple objective tools are still lacking.

Methods: A retrospective cohort study was conducted including adults admitted with CT-confirmed ASBO between 2020 and 2024. Demographics, comorbidities, laboratory values, PNI, PLR, radiologic parameters, and Antoine Béclère (AB) scores were collected. Predictors of surgery were examined using univariate and multivariable logistic regression. Diagnostic accuracy of the AB score was assessed using receiver operating characteristic (ROC) analysis.

Results: A total of 106 patients were included, of whom 51 (48.1%) required operative management. PNI and PLR did not differ significantly between operative and non-operative groups. Older age, higher comorbidity burden, and higher AB scores were associated with surgery. An AB score ≥2 predicted operative need in 82.4% of cases (p < 0.001). In multivariable analysis adjusted for age and Charlson index ≥4, an AB score ≥2 remained an independent predictor (OR 4.20). ROC analysis showed moderate discriminative ability for the AB score, with an AUC of 0.71, sensitivity of 82%, and specificity of 66.

Conclusion: The AB score helped identified patients unlikely to respond to conservative treatment, with a score ≥2 strongly associated with operative need. Its performance was not influenced by nutritional or inflammatory status. These findings highlight the clinical utility of simple, reproducible indicators in guiding early management of ASBO.

Background: Anticoagulant and antiaggregant drugs (commonly referred to as blood thinners) are widely used for various clinical indications. The most significant complication associated with these medications is hemorrhage. In this study, we evaluated patients receiving blood thinners who developed spontaneous chest wall hematomas.

Methods: Between January 2016 and December 2024, a total of 13 patients with a history of blood thinner use who developed spontaneous chest wall hematoma were referred to our clinic. The analysis included radiological findings, demographic characteristics, underlying pathologies, and treatment modalities.

Results: Nine of the 13 patients had no history of major chest wall trauma but presented with large or progressively enlarging hematomas, and therefore underwent surgical intervention with hematoma evacuation. Intraoperatively, no active bleeding source was identified; the hematomas were localized between the muscle fascia and were successfully evacuated. These patients were discharged with full recovery. During the course of medical treatment and follow-up, two of the four patients, who had poor overall clinical status, died.

Conclusion: Bleeding is the most significant adverse effect of blood thinner medications. Spontaneous chest wall hematoma is a rare clinical entity. Repetitive microtrauma, particularly in elderly or mobility-limited patients supported at the axillary or pectoral regions during positioning or mobilization, may contribute to hemorrhage and hematoma formation under the effects of anticoagulant therapy. Surgical drainage, when appropriately indicated, provides symptomatic relief and may help prevent secondary complications such as infection.

Background: This study aimed to identify prognostic factors in patients undergoing pars plana vitrectomy (PPV) following open globe injury (OGI) and to evaluate surgical outcomes of PPV in eyes with no light perception (NLP) at presentation after OGI.

Methods: We retrospectively reviewed the medical records of patients who underwent primary repair for severe ocular trauma, subsequently required PPV due to posterior segment damage, and had a minimum follow-up of 6 months. Patients were divided into two groups based on initial best-corrected visual acuity (BCVA): Group 1, no light perception (NLP); and Group 2, light perception (LP) or better. Clinical characteristics, as well as final anatomical and visual outcomes, were compared between the groups. Additionally, the role of PPV was specifically evaluated in eyes that were most severely affected by trauma and presented with NLP after primary repair.

Results: A total of 47 eyes from 47 patients were included. Twelve eyes had NLP after primary repair for OGI. Among these, five eyes remained NLP, two (16.7%) improved to light perception (LP), three (25.0%) to hand motion, one (8.3%) to counting fingers, and one (8.3%) achieved a visual acuity of 20/60 at final follow-up. Final anatomical success was achieved in 39 of 47 eyes (82.9%). Visual improvement was observed in 91.4% of eyes (32/35) with preoperative visual acuity of at least LP, and in 58.3% of eyes (7/12) with NLP prior to vitrectomy. No eyes required enucleation. Retinal detachment (p<0.001), retinectomy (p=0.01), silicone oil use (p=0.001), and the need for a second vitrectomy (p=0.019) were associated with poor prognosis.

Conclusion: In patients with loss of LP secondary to severe ocular trauma, PPV can achieve high rates of anatomical success, with a significant proportion regaining ambulatory vision when appropriate surgical techniques are employed.