We describe a patient who sustained a penetrating injury to the posterior right lower extremity just above the popliteal region with transection of the superficial femoral artery (SFA) despite minimal evidence of active bleeding. An on-table angiogram identified flow in the SFA followed by the popliteal artery and into the trifurcation of the right lower extremity. Eventually, a second operation revealed transection followed by end-to-end anastomosis of SFA and stabilization of the patient. The findings of this case highlight the need for a high index of suspicion and persistent clinical investigation to identify vascular injuries in the absence of hard signs of vascular trauma.

HighlightsSeroma is a common and challenging post-operative complication for both surgeons and patients.Doxycycline can be a simple, safe and effective method for resolution of chronic seroma.Negative Pressure Wound Therapy System can induce seroma cavity collapse and surface adherence.

HighlightsGastric volvulus may have a chronic component which can then progress to an acute surgical emergency.Acute on chronic gastric volvulus is extremely challenging to diagnose given the vague and atypical abdominal complaints.When gastric volvulus evolves to acute in nature, the appropriate workup for an acute abdomen should be performed.Prompt evaluation with surgical intervention is key in the management of acute gastric volvulus to avoid complications such as gastric necrosis.

Nucleated red blood cells have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of nucleated red blood cells in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient.In this retrospective observational study conducted from 2012 to 2017. Inclusion criteria for the purpose of this study included all burn patients with total body surface area > 10% that were age ≥ 15 years. Demographic and clinical data collected from the electronic medical record. Data analysis consisted of descriptive and comparative analysis using SPSS.Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for nucleated red blood cells. The presence of nucleated red blood cells had an increased mortality rate with an odds ratio of 6.0 (p = 0.001; 2.5, 14.5), were more likely to appear in older patients (p<0.001), and were associated with increased hospital length of stay (p<0.001), injury severity scores (p<0.001), and complications.The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death the presence of NRBCs portend.

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