Damage control laparotomy in trauma

Jensen, S.; Cotton, Bryan A.

doi:10.1002/bjs.10519

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…Multivariate analysis indicated that preoperative hemodynamic instability was also an independent risk factor for surgery prognosis in pancreatic trauma. Traumatic bleeding is the most common cause of hemodynamic instability [14]. Approximately 80% of patients with hemorrhagic shock die in the operating room, and nearly 50% of patients with hemorrhagic shock die within the first 24 hours after injury.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Outcome and Survival after Laparotomy in Patients with Pancreatic Trauma: One Single-center Experience.

Yang¹,

Liu²,

Wu³

et al. 2020

Preprint

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Background: Pancreatic trauma results in significant morbidity and mortality. Few studies have investigated the postoperative prognostic factors in patients with pancreatic trauma after surgery. Methods: A retrospective study was conducted on 152 consecutive patients with pancreatic trauma who underwent surgery in Jinling Hospital, a national referral trauma center in China, from January 2012 to December 2019. Univariate and binary logistic regression analyses were performed to identify the perioperative clinical parameters that may affect the morbidity of the patients. Results: A total of 184 patients with pancreatic trauma were admitted during the study period, and 32 patients with nonoperative management were excluded. The remaining 152 patients underwent laparotomy due to pancreatic trauma. Sixty-four patients were referred from other centers due to postoperative complications. Abdominal bleeding caused by pancreatic leakage ( 10 of all deaths) and severe intra-abdominal infection (12 of all deaths) were the major causes of mortality. Twenty-eight (77.8%) of the 36 patients who had damage control laparotomy survived. Univariate analysis showed that age, hemodynamic status, and injury severe score (ISS) as well as postoperative serum levels of C-reactive protein (CRP), procalcitonin, albumin and creatinine and the volume of intraoperative blood transfusion had significant effects on the mortality ( P <0.05). Binary logistic regression analysis showed that the independent risk factors for prognosis after pancreatic trauma surgery were age ( P =0.012), preoperative hemodynamic instability ( P =0.018), postoperative CPR ≥154 mg/L ( P =0.016), and postoperative serum creatinine ≥177 μmol/L ( P =0.017). The 30-day mortality rate was 15.8%. Conclusions: In this single-center retrospective study, we first demonstrated that severe intra-abdominal infection and bleeding were the major factors affecting the prognosis of patients with pancreatic trauma after surgery. Preoperative hemodynamic instability, severe postoperative inflammation (CRP ≥154 mg/L) and acute renal failure (creatinine ≥177 μmol/L) were associated with a significant risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Outcome and Survival after Laparotomy in Patients with Pancreatic Trauma: One Single-center Experience.

Yang¹,

Liu²,

Wu³

et al. 2020

Preprint

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“…Notably, in the emergency and life-threatening scenario, the immediate goal is the closure of fascial defect as early as possible without triggering or exacerbating the lethal abdominal compartment syndrome (11)(12)(13). However, the management of these patients gives rise to a daunting challenge for surgeons.…”

Section: Introductionmentioning

confidence: 99%

Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

Zou

zhang

et al. 2020

Preprint

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Reconstruction of abdominal wall defects is still a big challenge in surgery, especiallywhere there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired.Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

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