J Trauma
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Traumatic hemipelvectomy is a catastrophic injury resulting from violent blunt shearing forces which cause massive skin, bone, and soft-tissue destruction. The initial extent of the injury as well as the complexity of the consequent problems is staggering. As such it constitutes one of the major challenges seen by trauma surgeons. ⋯ The University of California at Davis General Surgery Trauma Service admitted 9,369 major trauma victims from June 1985 to May 1988. During this 3-year period eight patients sustained a traumatic hemipelvectomy, of whom three survived. Given the complexity, yet rarity, of this injury, a review of the world literature was undertaken to compile collective experiences to aid surgeons in the management of this injury.
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Comparative Study
Emergency Department thoracotomy in children--a critical analysis.
Recent clinical reviews have helped to clarify the role of Emergency Department (E. D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. ⋯ Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2% salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E. D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.
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Pulmonary contusion is the usual manifestation of lung parenchymal injury following blunt chest trauma. With rapid deceleration, however, parenchymal lacerations can result in cavities best termed post-traumatic pulmonary pseudocyst (PPP). This report discusses eight adult PPP cases encountered at the Denver General Hospital over the past 30 months. ⋯ Computed tomography of the chest was pursued in complicated patients and clearly influenced therapy. Three (38%) pseudocysts developed into lung abscesses; two required resection and the other responded to percutaneous drainage. Although previously described as a benign pediatric entity, in our adult experience, PPP may result in a recalcitrant lung abscess requiring aggressive intervention.
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To ascertain morbidity and disability associated with vigorous attempts at limb salvage after lower extremity combined orthopedic and arterial injuries we reviewed more than 10,000 trauma admissions. Twenty-two patients (0.2%) suffered 14 blunt and eight penetrating lower extremity orthoarterial injuries. In all, more than 90 extremity operations were performed within 30 days of admission. ⋯ Tremendous effort was expended to achieve limb salvage in the patients of this review. Patients who underwent amputation had the more uneventful hospitalizations and the lower rates of disability. The notion that limb salvage need to be obtained in all patients at all costs may often lead to the triumph of technique and technology over reason.
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Multicenter Study Clinical Trial
Nonoperative management of blunt splenic trauma: a multicenter experience.
The experience of six referral trauma centers with 832 blunt splenic injuries was reviewed to determine the indications, methods, and outcome of nonoperative management. During this 5-year period, 112 splenic injuries were intentionally managed by observation. There were 40 (36%) patients less than 16 years old and 72 adults. ⋯ This contemporary multicenter experience suggests that patients with Class I, II, or III splenic injuries after blunt trauma are candidates for nonoperative management if there is: 1) no hemodynamic instability after initial fluid resuscitation; 2) no serious associated abdominal organ injury; and 3) no extra-abdominal condition which precludes assessment of the abdomen. Strict adherence to these principles yielded initial nonoperative success in 98% of children and 83% of adults. Application of standard splenic salvage techniques to treat the patients with persistent hemorrhage resulted in ultimate splenic preservation in 100% of children and 93% of adults.