Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chin ese Trauma Surge on Associati on orga nized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries.Eleven questions regarding the use of VSD in abdominal surgeries were addressed:(1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions?(2) Can VSD be preventively used for a high-risk abdominal incision w让h primary suture?(3) Can VSD be used in severely contaminated/infected abdominal surgical sites?(4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome?(5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage?(6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula?(7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess?(8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects?(9) Does VSD in crease the risk of bleeding?(10) Does VSD increase the risk of intestinal wail injury?(11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

Risk factors associated with the progression of extra-axial hematoma in the original frontotemporoparietal site after contralateral decompressive surgery in traumatic brain injury patients

Purpose:To introduced our experience with progressive extra-axial hematoma(EAH)in the original frontotemporoparietal(FTP)site after contralateral decompressive surgery(CDS)in traumatic brain injury patients and discuss the risk factors associated with this dangerous situation.Methods:This retrospective study was conducted on 941 patients with moderate or severe TBI treated in Daping Hospital,Army Medical University,Chongqing,China in a period over 5 years(2013e2017).Only patients with bilateral lesion,the contralateral side being the dominant lesion,and decompressive surgery on the contralateral side conducted firstly were included.Patients were exclude if(1)they underwent bilateral decompression or neurosurgery at the original location firstly;(2)although surgery was performed first on the contralateral side,surgery was done again at the contralateral side due to rebleeding or complications;(3)patients younger than 18 years or older than 80 years;and(4)patients with other significant organ injury or severe disorder or those with abnormal coagulation profiles.Clinical and radiographic variables reviewed were demographic data,trauma mechanisms,neurological condition assessed by Glasgow coma scale(GCS)score at admission,pupil size and reactivity,use of mannitol,time interval from trauma to surgery,Rotterdam CT classification,type and volume of EAH,presence of a skull fracture overlying the EAH,status of basal cistern,size of midline shift,associated brain lesions and types,etc.Patients were followed-up for at least 6 months and the outcome was graded by Glasgow outcome scale(GOS)score as favorable(scores of 4e5)and unfavorable(scores of 1e3).Student's t-test was adopted for quantitative variables while Pearson Chi-squared test or Fisher's exact test for categorical variables.Multivariate logistic regression analysis was also applied to estimate the significance of risk factors.Results:Initially 186 patients(19.8%)with original impact locations at the FTP site and underwent surgery were selected.Among them,66 met the inclusion and exclusion criteria.But only 50 patients were included because the data of the other 16 patients were incomplete.Progressive EAH developed at the original FTP site in 11 patients after the treatment of,with an incidence of 22%.Therefore the other 39 patients were classified as the control group.Multivariate logistic regression analysis showed that both the volume of the original hematoma and the absence of an apparent midline shift were significant predictors of hematoma progression after decompressive surgery.Patients with fracture at the original impact site had a higher incidence of progressive EAH after CDS,however this factor was not an important predictor in the multivariate model.We also found that patients with progressive EAH had a similar favorable outcome with control group.Conclusion:Progressive EAH is correlated with several variables,such as hematoma volumes10 mL at the original impact location and the absence of an apparent midline shift(<5 mm).Although progressive EAH is devastating,timely diagnosis with computed tomography scans and immediate evacuation of the progressive hematoma can yield a favorable result.

Protective effects of ischemic postconditioning on intestinal mucosa barrier function in rabbits with crush injury of hind limb： an experimental study

探索二的保护的效果的目的与后部的手足的压碎损害在肠的 mucosa 障碍上 ischemic postconditioning (IP ) 录入兔子。这研究在损伤外科的部门在 8 月和 2008 年 12 月之间被进行的方法，弹跳的医院，第三所军事医药大学，重庆，中国。对兔子的后部的手足的压碎损害的模型被 25 kg 目标第一开发，恰好后部的手足由木藤条修理了，然后 IP 的二种类型包括堵塞/打开被建立普通肠骨的动脉和静脉或者(传统的 IP ， IP A )并且 binding/loosening 受伤后部的手足的 proximum 或者(修改 IP ， IP B )。36 只雄的新西兰白兔子随机被划分成三个组：IP A 组， IP B 组和控制组织，带着在每个组的 12 只兔子。肼 oxidase (DAO ) 和肠的丰满的酸绑定的蛋白质(I-FABP ) 的浆液层次在损害以后在 2， 6， 12 和 24 个小时被检测。回肠的病理学的变化在损害以后在 24 个小时被检验。浆液在 IP A 和 IP B 组在损害以后在 2， 6， 12 和 24 个小时 I-FABP 铺平的结果有重要减少，与控制组相比。DAO 层次也在损害以后在 2 和 6 个小时显示出一样的变化趋势，但是没显示出二个 IP 组之间的重要差别。在回肠的病理学的变化的差别都没在三个组之中被发现。结论 IP 能在兔子在后部的手足压碎损害的模型上保护肠的 mucosa 障碍功能。同时，修改 IP B 显示出象传统的 IP A 的一样的保护，并且值得在诊所适用。

Treatment of abdominal injuries:a report of 522 cases

Objective: To make a summary of the experiences in the treatment of abdominal injuries.Methods: A retrospective study was done on 522 cases of abdominal injuries in our department from January 1986 to December 2004. Results: Of all, 382 cases were treated by surgery and 140 by conservative method. Among the surgically treated cases, 347 patients (90.8%) recovered, 35 (9.2%) died and 21 had postoperative complications (5.6% ). For patients undergoing conservative treatment,139 (99.3% ) recovered but one (0.7% ) died.Conclusions: The severity of abdominal injury and delayed treatment are two key factors leading to death.Surgical procedure is still the main method against alternative abdominal injuries. It is necessary to strictly control the indications in conservative treatment.

Surgical treatment strategy for multiple injury patients in ICU

目的将在 ICU 与多重损害为病人调查外科的治疗。病人们从 2006 年 1 月承认了到我们的医院的 ICU 到 2009 年 1 月的 163 多重损害的方法临床的数据回顾地被学习，包括 118 男性和 45 女性，与 36.2 年的吝啬的年龄(范围， 5-67 年) 。包括的损害区域出发，颈(29 个案例) ，脸(32 个案例) ，胸(89 个案例) ，腹部(77 个案例) ，骨盆和手足(91 个案例) 和身体出现(83 个案例) 。有 57 个案例，与吃惊相结合。ISS 价值从 10 ～ 54 变化了， 18.42 平均。病人们分别地在在内的 ICU 接受了外科的治疗 24 个小时(10 个案例) ， 24-48 小时(8 个案例) ， 3-7 天(7 个案例) 和 8-14 天(23 个案例) 。为 163 个病人，结果 ICU 停留的持续时间从 2 ～ 29 天，与 7.56 天的平均价值。在他们之中， 143 被治好(87.73%) ， 11 由于严重出血性的吃惊(6 个盒子) 在医院(6.75%) 里死了， craniocerebral 损害(3 个盒子) 和多重机关失败(2 个盒子) ，并且 9 在自愿地从医院(5.52%) 排出以后死了。全部的死亡率是 12.27% 。当多重损害病人在 ICU 被复活时，损坏控制原则应该被跟随的结论。外科的治疗策略活跃地包括控制出血，对待以前错过的损害和相关创伤或外科的复杂并发症并且动计划阶段手术。