Alterations in the Systemic Inflammatory Response after Early Total Care and Damage Control Procedures for Femoral Shaft Fracture in Severely Injured Patients

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

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Vacuum-assisted closure (VAC) for craniocerebral wounds in severely injured patients: technical note of a damage control procedure

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2019-001201 ◽

2019 ◽

Vol 165 (6) ◽

pp. e1-e1

Author(s):

Christophe Joubert ◽

A Sellier ◽

J-B Morvan ◽

N Beucler ◽

J Bordes ◽

...

Keyword(s):

Damage Control ◽

Injured Patient ◽

Technical Note ◽

Cerebrospinal Fluid Leakage ◽

Control Procedure ◽

Illustrative Case ◽

Severely Injured ◽

Vacuum Assisted Closure ◽

Severely Injured Patients ◽

Injured Patients

The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described—but not exclusively trauma—cases with no secondary cerebrospinal fluid leakage encountered.

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