Langenbeck's archives of surgery
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Langenbecks Arch Surg · Feb 2004
Efficiency of small-volume resuscitation in restoration of disturbed skeletal muscle microcirculation after soft-tissue trauma and haemorrhagic shock.
Despite advances in primary care, trauma in conjunction with shock remains the leading cause for morbidity and mortality of young adults in western countries. Herein, we report on the efficiency of small-volume resuscitation to improve compromised perfusion of traumatised skeletal muscle tissue in shock. ⋯ Resuscitation with HyperHES is as effective as HES in improving capillary perfusion in traumatised skeletal muscle during haemorrhagic shock. However, because values of functional capillary density in the HyperHES-treated and HES-treated animals were still markedly below those reported in traumatised skeletal muscle of normovolaemic animals, further tools are needed to enhance efficiency in treatment of local skeletal muscle tissue injury during haemorrhagic shock.
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Langenbecks Arch Surg · Oct 2003
Temporal profile of microvascular disturbances in rat tibial periosteum following closed soft tissue trauma.
Bone devascularization due to impaired periosteal perfusion following fracture with severe soft tissue trauma has been proposed to precede and underlie perturbed bone healing. The extent and temporal relationship of periosteal microcirculatory deteriorations after severe closed soft tissue injury (CSTI) are not known. We hypothesized that periosteal microcirculation is adversely affected and the manifestation of trauma-initiated microvascular impairment in periosteum is substantially prolonged following CSTI. ⋯ Isolated CSTI in absence of a fracture exerts long-lasting disturbances in periosteal microcirculation, suggesting a delayed temporal profile in manifestation of CSTI-induced periosteal microvascular dysfunction and inflammation. These observations may have therapeutic implications in terms of preserving periosteal integrity and considering the interaction of skeletal muscle damage and periosteal microvascular injury during management of musculoskeletal trauma.
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Langenbecks Arch Surg · Oct 2003
Experimental models to study microcirculatory dysfunction in muscle ischemia-reperfusion and osteomyocutaneous flap transfer.
During the past decade, experimental studies have provided convincing evidence that microcirculatory dysfunction plays a pivotal role in the manifestation of tissue injury in ischemia-reperfusion and osteomyocutaneous flap transfer. The study of the mechanisms of injury, however, requires sophisticated experimental in vivo models. With the use of microsurgical techniques, osteomyocutaneous flap transfer can successfully be performed in rat hind limbs, allowing in vivo fluorescent microscopic analysis of post-ischemic microcirculatory dysfunction in all tissues involved, including periosteum, striated muscle, subcutis and skin. The drawback of this "acute" model is that the period of analysis is restricted to a few hours only. ⋯ These experimental results not only demonstrate the importance of the use of advanced in vivo methods to delineate pathophysiological mechanisms in complex disease models, but may also provide a basis for potential prospective randomized trials to test the benefit for the patient in the daily clinical routine.
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Langenbecks Arch Surg · Jul 2003
Incisional hernia repair after orthotopic liver transplantation: a technique employing an inlay/onlay polypropylene mesh.
The literature provides no data on the incidence and operative management of incisional hernias developing after orthotopic liver transplantation. The use of high-dose immunosuppressive agents results in an appreciable delay in wound healing. There is thus a need for a procedure for the reconstruction of the abdominal wall for patients on immunosuppression. The aim of this retrospective study was to establish the incidence of incisional hernias and an analysis of the results after implantation of a polypropylene mesh in inlay-onlay technique after liver transplantation is given. ⋯ In patients after liver transplantation, the implantation of a polypropylene mesh proved to be an efficient and safe method of treating incisional hernias. Implantation of a mesh was not associated with an increased infection rate, despite the use of immunosuppression. In view of the high recurrence rate associated with primary closure, mesh implantation should be given preference.
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Langenbecks Arch Surg · Apr 2003
Randomized Controlled Trial Clinical TrialEffect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is associated with a high incidence of postoperative pain, nausea, and vomiting. Pneumoperitoneum created during the operation and residual gas after the operation are two of the factors in postoperative pain and nausea. We studied the effects of a subdiaphragmatic gas drain, which is intended to decrease the residual gas, on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy. ⋯ Subdiaphragmatic drain offers only minor, if any, benefit on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy, and this effect is probably clinically irrelevant.