The Surgical clinics of North America
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Acute mesenteric ischemia is uncommon and always occurs in the setting of preexisting comorbidities. Mortality rates remain high. ⋯ Prompt diagnosis requires attention to history and physical examination, a high index of suspicion, and early contract CT scanning. Selective use of nonoperative therapy has an important role in nonocclusive mesenteric ischemia of the small bowel and colon.
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The open abdomen has become the standard of care in damage-control procedures, the management of intra-abdominal hypertension, and in severe intra-abdominal sepsis. This approach has saved many lives but has also created new problems, such as severe fluid and protein loss, nutritional problems, enteroatmospheric fistulas, fascial retraction with loss of abdominal domain, and development of massive incisional hernias. Early definitive closure is the basis of preventing or reducing the risk of these complications. The introduction of new techniques and materials for temporary and subsequent definitive abdominal closure has improved outcomes in this group of patients.
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Necrotizing skin and soft tissue infections are severe bacterial infections resulting in rapid and life-threatening soft tissue destruction and necrosis along soft tissue planes.