Figure 6 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
A) Infected pleural and mediastinal wound; B) Vacuum dressing aspect with sponges, suction drain and adhesive drape; C) Evolution of the wound with sanitation of the pleural space and development of granulation tissue; D) Final phase of wound evolution, with obliteration of the pleural space and exuberant granulationtissue; after this phase a skin flap was performed, with satisfactory functional and aesthetic result.
Source publication
ABSTRACT The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis pati...
Similar publications
![Table 3 Cerebrovascular injury grading scale [Biffl et al. (30)]](profile/Roozbeh-Shafafy/publication/318074602/figure/tbl3/AS:667086632255494@1536057255191/Cerebrovascular-injury-grading-scale-Biffl-et-al-30_Q320.jpg)
Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the opti...
![Table 1 . AAST Liver Trauma Classification [11].](profile/Abdallah-Taha/publication/330170707/figure/tbl1/AS:711785841688576@1546714377036/AAST-Liver-Trauma-Classification-11_Q320.jpg)
Background: Liver is the most injured organ in abdominal trauma. The management of blunt liver trauma has markedly changed in the last three decades with a significant improvement in outcomes, due to improvements in diagnostic and therapeutic aids. This study details incidence, grades, causes, types and management of blunt isolated liver trauma in...
The overarching goal of the gathering was to define a concept for technology design research in Giessen to improve patient outcomes through the design of assistive technology that assists both patients and surgeons.
The emerging field of regenerative rehabilitation where trauma patients are treated by methods of regenerative medicine promises grea...
Citations
... This necessitated the optimisation of surgical tactics on admission in accordance with the principles of DCS (damage control surgery) technology, which prioritises the severity of physiological diseases over anatomical ones. The majority of studies on DCS tactics focus on abdominal trauma, while thoracic trauma is underrepresented [16,21]. And there are practically no publications on the application of DCS technology in the case of sternocostal framework instability [26]. ...
Thoracic trauma, often characterised as closed, comprises 23% to 56.9% of polytrauma cases.According to our research, flail chest in thoracic trauma occurs in approximately 7.9—8.9% of cases. The primary factors contributing to this instability are car accidents or falls from a height. Objective — to enhance the outcomes of surgical treatment for patients with flail chest by applying novel techniques for assessing the severity of injuries and implementing improved surgical tactics. Materials and methods. The study included a total sample of 123 patients who had flail chest. The participants were divided into 2 groups: the control group (n=56) and the comparison group (n=67). The ATS scale was used to assess the severity of the condition in the groups. The injury severity score was determined using a point‑based system and categorised as minor, severe, or extremely severe. The control group was additionally evaluated using the AdTS scale, while the perfusion index was measured. Results. The injury severity score determined using the AdTS scale and the perfusion index formed the basis of an algorithm for differential diagnosis that influenced the indication area and scope of diagnostic procedures. The choice of surgical tactics was based on the results of an additional examination and the injury severity score. For a minor injury, the full range of medical procedures was carried out. For a severe injury, a shortened list of procedures was prescribed. In the case of an extremely severe injury, care was provided using the principles of DCS technology. The chest stabilisation procedure was conducted using the suggested approach for assessing the severity of the injury: less traumatic operations were performed for severe injuries, while full‑scale operations were carried out for minor injuries. The selection of the method for stabilising floating segments was based on the established classification of chest instability. The stabilisation of flail chest was carried out either during the first or third phase of the DCS technology or after the patient had been brought out of a state of shock, in accordance with delayed indications. Conclusions. The application of the AdTS anatomical and functional scale and the determination of the perfusion index allowed for a rapid and objective evaluation of the injury severity score (minor, severe, and extremely severe). Additionally, these tools helped in identifying the appropriate diagnostic procedures and deciding on the method for stabilising the flail chest. The differential diagnostic programme implemented in the control group made it possible to reduce the examination time for patients with an extremely severe injury by 9.8±1.1 minutes. Implementing the proposed injury severity assessment and stabilisation tactics decreased the number of late purulent‑septic complications by 19.8% and mortality by 17.4% (from 38.8% to 21.4%).
... -Arteries: ligation of the thoracic arteries is an exceptional situation; flow in the aorta, brachiocephalic trunk, and intrathoracic segments of the common carotid arteries should be maintained whenever possible (1C). 17,21,46 Which access routes are used for thoracic vascular injuries? When should imaging tests be used to diagnose vascular injury? ...
Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.
... Modeling was performed using MIMICS software, and the green area represents the preoperative thoracic volume (E) The yellow area represents the postoperative thoracic volume, which increased significantly compared to the preoperative one (F). Frontiers in Surgery trauma to cardiothoracic surgery and has made great progress, significantly reducing the mortality of patients with severe chest trauma (15,16). According to DCS and pathophysiology, multiple rib fractures do not need to be completely fixed; only the important part needs to be fixed to restore the stability of the thorax, maintain normal physiological function, effectively relieve chest pain, and facilitate accelerated rehabilitation (17,18). ...
Background
Flail chest is a common and serious traumatic condition in thoracic surgery. The treatment of flail chest often includes open reduction and internal fixation, which is relatively traumatic, complicated, and expensive. As three-dimensional (3D) printing technology is widely used in the clinical field, the application of 3D-printed products to chest trauma will become a new treatment option. To date, the use of 3D-printed external fixation guides for flail chests has not been reported. Thus, we aimed to assess the short-term efficacy of a new technology that treated flail chests with an individualized 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery (VATS).
Patients and methods
A retrospective analysis was performed on patients with flail chest treated with this new technique at our center from January 2020 to December 2022. The following parameters were included: operative time, thoracic tube extraction time, intensive care unit time, thoracic volume recovery rate, visual analog scale score 1 month postoperatively, and postoperative complication rate. All patients were followed up for at least 3 months.
Results
Five patients (mean age: 45.7 years) were enrolled; they successfully underwent surgery without chest wall deformity and quickly returned to daily life. The average number of rib fractures was 8.4; all patients had lung contusion, hemopneumothorax, and anomalous respiration. The abnormal breathing of all patients was completely corrected on postoperative day 1, and the chest wall was stable. One case experienced mild loosening of the 3D-printed guide postoperatively; however, the overall stability was not affected. The other four cases did not experience such loosening because we replaced the ordinary silk wire with a steel wire. All cases were discharged from the hospital 2 weeks postoperatively and returned to normal life 1 month after the removal of the 3D-printed guide on average. Only one case developed a superficial wound infection postoperatively, and no perioperative death occurred.
Conclusions
The 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery is a novel technique in the treatment of flail chest and is safe, effective, feasible, and minimally invasive, with satisfactory clinical efficacy.
... capacidad de un barco militar de absorber un daño y continuar con la misión" de ahí deriva el término cirugía de control de daños, y el término resucitación de control de daños. 3,4 Se ha demostrado que al combinarse ambos métodos de control de daños se obtiene una supervivencia aproximada de 60 a 90% en comparación con el uso de estos métodos por separado de 58%. Feliciano también demuestra una supervivencia de 90% en su serie de investigación. ...
Introducción:
la cirugía de control de daños, se refiere a la culminación rápida de una cirugía después de controlar el sangrado que puede amenazar la vida y evitar la contaminación para luego llegar a la corrección de las anormalidades fisiológicas y manejo definitivo, encaminado a evitar la tríada letal.
Objetivo:
determinar los parámetros clínicos, laboratoriales y estancia en unidad de cuidados intensivos que se utilizarán con mayor frecuencia para el ingreso a la tercera etapa en la cirugía de control de daños.
Material y métodos:
estudio retrospectivo observacional, se analizaron 30 expedientes de pacientes sometidos a cirugía de control de daños en el Hospital General de Querétaro, teniendo como variables pH, numero de transfusiones sanguíneas, tiempos de coagulación, temperatura, estancia en unidad de cuidados intensivos y hemoglobina.
Resultados:
80% población masculina, edad media de 43.5 años, estancia en unidad de cuidados intensivos de 41 horas, hemoglobina promedio de 12 g/dl al entrar a tercera etapa de cirugía de control de daños, temperatura media de 36.56 grados, pH de 7.33 y una media de transfusiones de 3.3 paquetes globulares.
Conclusiones:
con el presente ubicamos en un panorama internacional de nuestro actuar en la segunda etapa de cirugía de control de daños, en la cual podemos mejorar indudablemente para así ofrecer mejores resultados a nuestros pacientes a corto, mediano y largo plazo.
... 16 as injúrias e as medidas clínicas associadas, existe a possibilidade de que nesse intervalo, seja restabelecido os parâmetros fisiológicos do paciente instável. 18 A fim de que se cumpram esses objetivos, a CCD baseia-se em cinco estágios: Indicação cirúrgica (Estágio 01), laparotomia abreviada (Estágio 02), medidas clínicas de ressuscitação para normalização dos parâmetros (Estágio 03), reabordagem cirúrgica com tratamento definitivo (Estágio 04) e a fase de reabilitação (Estágio 05). 20 Algumas técnicas como: Ligadura de vasos, Shunt arterial temporário 17 , tamponamento com compressas e balões, ressecções, ligadura de alças intestinais com fitas cardíacas, coledocostomia, ureterostomia, sutura simples contínua de vísceras ocas são medidas importantes empregadas a fim de que o tempo de laparotomia seja reduzido e haja o controle temporário da hemorragia e contaminação. ...
... On the other hand, Gonçalves et al. indicated that situations involving DCS in the chest wall could be divided into the control of parietal bleeding and the temporary closure of the chest wall. The temporary closure (abbreviated thoracotomy) has been reported in two situations, including a thoracic packing for coagulopathy and a restriction of heartbeats due to wall closing [2,3]. However, there has been no concept of DCS for the chest wall, especially unstable thoracic cage injuries. ...
Damage control surgery (DCS) consists of three steps: an abbreviated initial operation, resuscitation in the ICU, and a planned reoperation. Although DCS for lung and heart injury have been established, there is no concept of DCS for the chest wall. We experienced a successful case, in which a DCS of chest wall lifting procedure and internal pneumatic stabilization were performed on the flail chest accompanied by a remarkable destruction of chest wall. As a result, the patient's abnormal breathing improved. Surgical fixations using KANI plate were performed at a later date. We suggest that the chest wall lifting procedure may be suitable as a DCS for thoracic cage destruction from severe chest wall injury.
... However, there are injuries, when an access to the back of the victim is needed, also. Isolated one lung intubation-one of the greatest achievements of chest surgery in the past half century-is a luxury in DCTS, few situation allows it (29). Horizontal sternotomy is preferred by many surgeons, as the anterior aspect of all intrathoracic organs is accessible. ...
Thoracic damage control surgery (TDCS) is a decision making tool and derivate of the damage control concept (DCC), where physiological stabilization has a priority over anatomical reconstruction under the pressure of time. Intrathoracic haemorrhage control and pleural decompression are the two main immediate tasks of TDCS, while definitive procedures follow when the patient is stabilised in 24-48 hours. The focus of the thoracic surgeon is on the prevention of the haemorrhage induced coagulopathy, metabolic acidosis and hypothermy formed triad of death. Surgical haemorrhage control and pleural space decompression are to be performed. The individual patients beneft from TDCS procedures whose condition is too severe for a complex immediate reconstruction (polytrauma). Life threatening chest injuries in multiple/mass casualty scenarios in civilian and military environment alike are triaged and treated accordingly. Onset of acute mismatch between the resources (available hands, OP theaters, resources, hardware) and the needs (number and severity of chest trauma cases), a mindset shift should take place, where time and space the two main limiting factors. Airway obstruction, tension haemo/pneumothorax falls into the preventable death category. Chest drainage and emergency thoracotomy are the two main procedures offered by TDCS. An intervention structured organ/injury specifc list of procedures is detailed. This is a mix of emergency surgery and cardiothoracic surgery, where less is more. TDSC is not the Holy Grail found to solve all complex thoracic trauma cases, but is a good tool to increase the chance for survival in challenging, and frequently quite hopeless situations.
... The incidence of mediastinitis (with a 50% associated mortality) is high with esophageal injury and especially if presenting late. In the case of any injury of the mediastinum, a thought should be spared for possible esophageal injury and if suspected, all attempts should be made to diagnose and manage this early [18]. ...
... Goncalves and Saad very accurately describe the 3 clinical scenarios encountered in damage control surgery for thoracic vascular injury: active, externalized bleeding from an open wound, active bleeding into a compartment of the thorax (classically the pleural space or any of the anterior, middle, or posterior mediastinal compartments), or contained bleeding supported by evidence of a mediastinal or extrapleural hematoma [18]. Externalized bleeding can be temporized by a Foley's catheter with inflated balloon into the skin defect with an additional surrounding hemostatic purse string suture if needed. ...
Purpose of Review
An overview of the practice of damage control surgery in the thoracic trauma patient with emphasis on physiological resuscitation and specific management principles of damage to different organs in the chest.
Recent Findings
The advance of endovascular stents use for injuries of the large thoracic vessels can greatly assist in avoiding open surgery with major bleeding in a patient in physiological extremis. Extracorporeal membrane oxygenation (ECMO) can be used in those patients where conventional measures of resuscitation and oxygenation fail as an adjunct to restore normal physiology.
Summary
Thoracic damage control surgery can be employed successfully if the physiology of the patient is paramount during resuscitation chasing the specific goals of reversing the lethal triad of acidosis, coagulopathy, and hypothermia. Abbreviated surgical techniques which mainly achieve hemostasis and control air leaks needs to be carefully employed in the thoracic cavity where packing of organs for hemostasis can greatly compromise cardiorespiratory reserve.
... Thoracic trauma is responsible for approximately 25% of trauma deaths (1). Although often managed with conservative treatment, in some cases emergent surgery is required for severe intrathoracic and chest wall lesions (tension pneumothorax, massive hemothorax, and lung or myocardial injuries) (2). We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. ...
Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3rd postoperative day and patient was discharged on 14th postoperative day. He has already recovered his normal activity 6 months after surgery.
Resumo Trauma é uma causa importante de morbimortalidade, que acomete principalmente jovens. A hemorragia incoercível é o principal mecanismo de óbito precoce nessas vítimas, e as lesões vasculares não compressíveis representam grandes desafios para os cirurgiões. O traumatismo vascular impacta diretamente a viabilidade de membros traumatizados, aumentando o risco de amputação. Nas últimas décadas, muitas condutas de diagnóstico e tratamento de lesões vasculares traumáticas foram modificadas. A angiotomografia suplantou a angiografia como padrão ouro para diagnóstico, as técnicas endovasculares foram incorporadas ao arsenal terapêutico e o conceito de “controle de danos” foi estabelecido. No entanto, há lacunas na literatura nacional sobre a normatização de condutas em trauma vascular, principalmente considerando as limitações do Brasil. Por isso, a Sociedade Brasileira de Angiologia e de Cirurgia Vascular e a Sociedade Brasileira de Atendimento Integrado ao Traumatizado revisaram a literatura disponível sobre trauma vascular e organizaram diretrizes sobre o diagnóstico e tratamento dessas lesões.
