J Trauma
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In thoracic surgery, although infrequent, we encounter unexpected damage to the pulmonary artery (PA). In the present study, we evaluated the hemostatic efficacy of a newly developed fibrin-based sheet material, thrombin sheet, coupled with liquid fibrinogen (TSF), in an experimental model of PA hemorrhage. ⋯ The hemostatic efficacy of TSF was superior to TC in this particular experiment. Single application of TSF was sufficient to achieve hemostasis in all but one animal. Compression time of approximately 1 minute was also very short albeit that the bleeding was from the PA and not an artery. These results were presumably because the adhesion was stronger, faster, and the sheet was more pliable in TSF compared with TC.
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Comparative Study
Experimental study of controlled fluid resuscitation in the treatment of severe and uncontrolled hemorrhagic shock.
Hemorrhagic shock is a common clinic emergency case. The fluid resuscitation method in the presurgical care of hypotensive trauma patients is open to debate. This study was conducted to evaluate the general and pathophysiologic effects of controlled fluid resuscitation in the treatment of severe and uncontrolled hemorrhagic shock. ⋯ In severe and uncontrolled hemorrhagic shock, some fluid must be given in proper time to improve tissue perfusion and avoid early death. Among three fluid resuscitation methods, controlled fluid resuscitation can effectively decrease additional blood loss, avoid excessive hemodilution and coagulopathy, improve the early survival rate, and reduce the apoptosis of visceral organs in rats with severe and uncontrolled hemorrhagic shock. This model supports the concept that when surgical care is not readily available, controlled fluid resuscitation should be considered in the treatment of uncontrolled hemorrhagic shock.
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In patients with unstable pelvic ring fractures, the factors related to poor outcome are still controversial. The purpose of our study was to evaluate the long-term functional outcome of patients with unstable pelvic ring fractures and correlate it with various other factors. ⋯ The long-term functional outcome after unstable pelvic ring fracture was not associated with Injury Severity Score, fracture location or fracture type. We discovered a close correlation between neurologic injury and functional outcome.
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Major limb amputations are among the most debilitating wounds sustained by those who survive a combat injury and these injuries leave a lasting impression with the public. This article will review the history of major limb amputation in military trauma surgery. ⋯ Major limb amputation remains a fearsome outcome of limb injury. However, during the last 500 years, military trauma surgeons have solved the problems of bleeding, infection, and neurovascular repair after major limb injury such that amputation rates even during times of active military conflict are at historic lows.