Polski przeglad chirurgiczny
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Comparative Study
Evaluation of silver coated hemostatic dressing to control hemorrhage in a porcine model of lethal vascular injury.
An ideal hemostatic dressing that would control bleeding and protect the wound from further contamination is still being sought for combat casualty care. The new SilverLeaf™ (SL) bandage was made of material containing active hemostatic property and possible antimicrobial property from silver coating. This study was conducted to compare and ascertain the hemostatic properties of SL and compare it with known hemostatic dressings: Combat Gauze® (CG) and WoundStat™ (WS) in a swine model with punch, vascular injury. ⋯ The findings indicate that SilverLeaf, WoundStat and Combat Gauze were comparable in controlling bleeding, preventing re-bleeding, maintenance of mean arterial pressure and improving survival following treatment.
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The recurrent laryngeal nerve (RLN) is particularly prone to injury during thyroidectomy in case of extralaryngeal bifurcation being present in approximately one-third of patients near the inferior thyroid artery or ligament of Berry. Meticulous surgical dissection in this area may be additionally facilitated by the use of intraoperative neuromonitoring (IONM) to assure safe and complete removal of thyroid tissue. The aim of the study was to verify the hypothesis that meticulous surgical technique of tissue dissection in the area of the posterior surface of the thyroid capsule and adjacent RLN may be additionally facilitated by intraoperative neuromonitoring (IONM), and may contribute to increasing the safety and radicalness of total thyroidectomy in patients with well-differentiated thyroid cancer. ⋯ Most patients with WDTC who undergo total thyroidectomy have a small amount of residual thyroid tissue. The use of IONM may improve the outcomes of surgery among these patients by both increasing the completeness of total thyroidectomy and significantly reducing the prevalence of temporary RLN injury. The possible mechanism of this improvement is the aid in dissection at the level of the Berry's ligament offered by IONM which enhances the surgeon's ability to identify a branched RLN, and allows for reduction of traction injury and neuropraxia of the anterior branch of bifid nerves.
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Gunshot wounds are rare events in European countries, but stab and impalement injuries occur more frequently and are often spectacular. The aim of the study was to describe several types of penetrating abdomino-thoracic injuries as well as the appropriate surgical interventions, including complex wound management. ⋯ Penetrating abdomino-thoracic injuries demand immediate life-saving measures, transfer to a trauma centre, appropriate resuscitative care, prompt diagnosis, and surgical intervention by an interdisciplinary team of abdominal, vascular, and cardiac surgeons. If these measures are provided, outcomes are maximized, mortality is minimized, and permanent damage can be avoided.
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The introduction of markers which help in the identification of patients prone to suffer from postoperative complications enables to recognize them more easily and thus, treat them more effectively. THE AIM OF THE STUDY was to evaluate complete blood count indicators, as well as preoperative results obtained on the basis of the POSSUM and P-POSSUM scoring systems, considering the prediction of complications after surgical resections in the pancreato-duodenal area. ⋯ The absolute white blood cell count and total platelet count during the preoperative period may be considered as an indicator of the higher risk of complications during pancreato-duodenal area resections. The usefulness of the POSSUM and P-POSSUM scoring systems is limited. However, the surgical severity index and calculated mortality coefficient risk can facilitate the identification of patients threatened with postoperative complications.