RESUMEN
OBJECTIVE: Although the lack of health insurance has been linked to poor health outcomes in several diseases, this relationship is still understudied in trauma. There exist differences between the Puerto Rico health care system and that of the United States. We therefore aimed to assess mortality disparities related to insurance coverage at the Puerto Rico Trauma Hospital (PRTH). METHODS: A retrospective cohort study of patients who sustained penetrating injuries (presenting at the PRTH from 2000 to 2014) was performed. Individuals were classified by their insurance status. Study variables comprised demographics, clinical characteristics and outcomes. A logistic regression analysis was performed to identify the association between health insurance status and risk of dying. RESULTS: Patients with public health insurance experienced more complications than did individuals who had private health insurance (PrHI) or who were uninsured. This group had longer durations of mechanical ventilation and spent more time in the hospital than did patients who had PrHI or who were uninsured. However, uninsured patients with gunshot wounds were 54% (adjusted odds ratio = 1.54; 95% CI: 1.01, 2.36) more likely to die than were their counterparts who had PrHI. CONCLUSION: Our study suggests that having health insurance could reduce a given patient mortality risk in trauma settings. More studies with larger samples are warranted to confirm these findings. If these findings hold true, then providing equitable access to health services for the entire population could prevent patients suffering trauma from having premature, preventable deaths.
Asunto(s)
Disparidades en Atención de Salud , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud , Pacientes no Asegurados/estadística & datos numéricos , Calidad de la Atención de Salud , Heridas Penetrantes/etnología , Heridas Penetrantes/mortalidad , Cuidados Críticos/economía , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Puerto Rico/epidemiología , Estudios Retrospectivos , Heridas por Arma de Fuego/mortalidad , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapiaRESUMEN
Resumen Introducción: La terapia endovascular ha demostrado ser una buena alternativa de tratamiento en las enfermedades arteriales y venosas. Asimismo, en trauma vascular periférico constituye una excelente opción, especialmente en sitios anatómicos difíciles de acceder y con lesiones complejas como seudoaneurismas, fístulas arteriovenosas (FAV) o la combinación de ambos, con numerosas ventajas. Objetivo: Evaluar los resultados del tratamiento endovascular en trauma vascular penetrante por agresiones y iatrogenias. Materiales y Método: Revisión retrospectiva de todos los pacientes con trauma vascular periférico sometidos a terapia endovascular. Resultados: Entre abril de 2011 y mayo de 2020 se trataron 30 pacientes, 28 hombres y 2 mujeres. Con edades fluctuantes entre 17 y 84 años. La causa del trauma fue 20 penetrantes y 10 iatrogenias. Los vasos afectados fueron arteria femoral superficial 6, femoral profunda 2, subclavia 9, axilar 1, poplítea 4, ilíacas 1, peronea 1, tibial anterior 5, tronco venoso braquiocefálico 1. Diecisiete pacientes fueron tratados con endoprótesis, 9 con embolización y 4 con cierre percutáneo en relación con catéteres arteriales en subclavia. No hubo mortalidad, pero dos pacientes requirieron reparación abierta: un seudoaneurisma poplíteo gigante y un seudoaneurisma de tibial anterior, en ambos se constató sección completa de ambas arterias. El seguimiento clínico ha sido entre 30 días y 3 años. Conclusiones: En esta serie de casos, la terapia endovascular en lesiones de trauma vascular periférico ofrece excelentes resultados con baja morbimortalidad y permeabilidad aceptable a corto y mediano plazo.
Introduction: Endovascular therapy has proven to be a good treatment alternative in arterial and venous diseases. Likewise, in peripheral vascular trauma it is an excellent option, especially in anatomical sites that are difficult to access and with complex lesions such as pseudoaneurysms, arteriovenous fistulas (AVFs) or the combination of both, with numerous advantages. Aim: To evaluate the results of endovascular treatment in trauma Penetrating vascular injury and iatrogenesis. Materials and Method: Retrospective review of all patients with peripheral vascular trauma undergoing endovascular therapy. Results: Between April 2011 and May 2020, 30 patients were treated, 28 men and 2 women. With fluctuating ages between 17 and 84 years. The cause of the trauma was 20 penetrating and 10 iatrogenic. The affected vessels were superficial femoral artery 6, deep femoral 2, subclavian 9, axillary 1, popliteal 4, iliac 1, peroneal 1, anterior tibial 5, brachiocephalic venous trunk 1. Seventeen patients were treated with endoprosthesis, 9 with embolization and 4 with percutaneous closure in relation to arterial catheters in the subclavian. There was no mortality but two patients required open repair: a giant popliteal pseudoaneurysm and an anterior tibial pseudoaneurysm in which both sections of both arteries were found to be complete. Clinical follow-up was between 30 days and 3 years. Conclusión: In this serie, endovascular therapy in peripheral vascular trauma lesions offers excellent results with low morbidity and mortality and acceptable patency in the short and medium term.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Arterias/lesiones , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia , Procedimientos Endovasculares/métodos , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnóstico , Prótesis Vascular/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico.Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.
Asunto(s)
Algoritmos , Lesiones Cardíacas/cirugía , Técnicas de Ventana Pericárdica , Heridas Penetrantes/cirugía , Colombia/epidemiología , Drenaje , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/epidemiología , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Ilustración Médica , Complicaciones Posoperatorias , Irrigación Terapéutica , Ultrasonografía/métodos , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/epidemiologíaRESUMEN
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
El trauma de duodeno comúnmente se produce por un trauma penetrante que puede asociarse a lesiones vasculares y de órganos adyacentes. En el manejo quirúrgico se recomienda realizar un reparo primario o el empleo de técnicas quirúrgicas simples. Sin embargo, el abordaje de lesiones severas del duodeno es un tema controversial. Anteriormente, se han descrito técnicas como la exclusión pilórica o la pancreatoduodenectomía con resultados no concluyentes. El presente artículo presenta una propuesta del manejo de control de daños del trauma penetrante de duodeno, a través, de un algoritmo de cinco pasos. Este algoritmo plantea una solución para el cirujano cuando no es posible realizar el reparo primario. El control de daños del duodeno y su reconstrucción depende de una toma de decisiones respecto a la porción del duodeno lesionada y el compromiso sobre el complejo pancreatoduodenal. Se recomiendan medidas rápidas para contener el daño y se proponen vías de reconstrucción duodenal diferente a las clásicamente descritas. Igualmente, la probabilidad de complicaciones como fistula duodenales es considerable, por lo que proponemos, que el manejo de este tipo de fistulas de alto gasto se aborde por medio de una laparostomía retroperitoneal (lumbotomía). El abordaje del trauma penetrante de duodeno se puede realizar a través del principio "menos es mejor".
Asunto(s)
Algoritmos , Duodeno/lesiones , Heridas Penetrantes/cirugía , Hemorragia/terapia , Humanos , Ilustración Médica , Heridas Penetrantes/clasificación , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnósticoRESUMEN
Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.
El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.
Asunto(s)
Algoritmos , Colostomía , Consenso , Recto/lesiones , Heridas Penetrantes/cirugía , Colombia , Colon/lesiones , Tratamiento Conservador , Tacto Rectal , Humanos , Proctoscopía , Tomografía Computarizada por Rayos X/métodos , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapiaRESUMEN
RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.
ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.
Asunto(s)
Humanos , Femenino , Adolescente , Vagina/lesiones , Heridas Penetrantes/etiología , Coito , Vagina/cirugía , Enfermedades Vaginales/cirugía , Enfermedades Vaginales/etiología , Heridas Penetrantes/cirugía , Heridas Penetrantes/diagnóstico , Factores de Riesgo , Laceraciones , Membrana Mucosa/cirugía , Membrana Mucosa/lesionesRESUMEN
BACKGROUND: There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. METHODS: We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. RESULTS: The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5-99.5%] and 98.7% [CI] [92.8-99.8%] respectively, with a range of confidence [CI] of 95%. CONCLUSIONS: Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.
Asunto(s)
Traumatismos del Cuello/diagnóstico , Examen Físico/normas , Heridas Penetrantes/diagnóstico , Adulto , Femenino , Humanos , Masculino , Traumatismos del Cuello/patología , Traumatismos del Cuello/terapia , Estudios Retrospectivos , Índices de Gravedad del Trauma , Heridas Penetrantes/patología , Heridas Penetrantes/terapiaRESUMEN
BACKGROUND: Management of patients with thoracoabdominal penetrating injuries is challenging. Thoracoabdominal penetrating trauma may harbor hollow viscus injuries in both thoracic and abdominal cavities and occult diaphragmatic lesions. While radiological tests show poor diagnostic performance in these situations, evaluation by laparoscopy is highly sensitive and specific. Furthermore, minimally invasive surgery may avoid unnecessary laparotomies, despite concerns regarding complication and missed injury rates. The objective of the present study is to evaluate the diagnostic and therapeutic performance of laparoscopy in stable patients with thoracoabdominal penetrating injuries. METHODS: Retrospective analysis of hemodynamically stable patients with thoracoabdominal penetrating wounds was managed by laparoscopy. We collected data regarding the profile of the patients, the presence of diaphragmatic injury, perioperative complications, and the conversion rate. Preoperative imaging tests were compared to laparoscopy in terms of diagnostic accuracy. RESULTS: Thirty-one patients were included, and 26 (84%) were victims of a stab wound. Mean age was 32 years. Ninety-three percent were male. Diaphragmatic lesions were present in 18 patients (58%), and 13 (42%) had associated injuries. There were no missed injuries and no conversions. Radiography and computerized tomography yielded an accuracy of 52% and 75%, respectively. CONCLUSION: Laparoscopy is a safe diagnostic and therapeutic procedure in stable patients with thoracoabdominal penetrating wound, with low complication rate, and may avoid unnecessary laparotomies. The poor diagnostic performance of preoperative imaging exams supports routine laparoscopic evaluation of the diaphragm to exclude injuries in these patients.
Asunto(s)
Diafragma , Laparoscopía , Laparotomía , Uso Excesivo de los Servicios de Salud/prevención & control , Complicaciones Posoperatorias , Traumatismos Torácicos , Tomografía Computarizada por Rayos X/métodos , Heridas Punzantes , Traumatismos Abdominales/cirugía , Adulto , Brasil , Conversión a Cirugía Abierta/estadística & datos numéricos , Diafragma/diagnóstico por imagen , Diafragma/lesiones , Femenino , Hemodinámica , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Traumatismos Torácicos/etiología , Traumatismos Torácicos/fisiopatología , Traumatismos Torácicos/cirugía , Procedimientos Innecesarios , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugía , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnóstico , Heridas Punzantes/cirugíaRESUMEN
BACKGROUND: In many cases, the presence of periocular foreign bodies continues to be a diagnostic challenge and a dilemma regarding their management in most cases. The key lies in the type of material of the foreign body and its location in the orbit to determine its management. CLINICAL CASES: We present two cases of periocular foreign body; a description of the clinical presentation and their treatment are given in each case. A review and discussion of treatment is also included. CONCLUSION: It is important to know the indications for the medical and surgical management for periocular foreign bodies to offer an individualized and direct treatment for each patient.
Asunto(s)
Cuerpos Extraños , Órbita/lesiones , Heridas Penetrantes , Adulto , Niño , Femenino , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/terapia , Humanos , Masculino , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapiaRESUMEN
Ferimentos penetrantes em face podem ser causados por materiais de naturezas diversas. Fatores como tamanho do objeto e proximidade de estruturas anatômicas importantes devem ser considerados para remoção do corpo estranho. Os exames complementares para detecção de corpos estranhos em face envolvem radiografias planas, tomografia computadorizada e ressonância magnética. O objetivo deste trabalho é relatar o caso clínico de um corpo estranho em região infra-orbitária, bem como o tratamento cirúrgico empregado e a importância da abordagem precoce por serviços de Cirurgia e Traumatologia Bucomaxilofacial nos serviços de emergência
Facial penetrating wounds can be caused by many different objects. Factors as object size and proximity to important anatomic structures must be considered for the removal of foreign bodies. Additional exams could be use for detection of facial foreign bodies, such as plan radiographies, computed tomography and magnetic resonance. The aim of this study is to relate a clinical case of foreign body at infraorbitary region, the surgical treatment and the early approach by Bucomaxillofacial Trauma service at emergencies rooms
Asunto(s)
Humanos , Femenino , Adulto , Heridas Penetrantes , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapia , Traumatismos FacialesRESUMEN
A raíz de una publicación de 1945, se realiza una revisión acerca de las heridas penetrantes cardíacas: Los conceptos que han resistido el paso del tiempo, los que han cambiado, y las nuevas tendencias. Se compara con la publicación de hace 70 años y se ofrecen algunas conclusiones...
Following a 1945 publication, a brief review about penetrating heart wounds is performed: The concepts that have stood the test of time, those have changed, and the new trends. We compare with the publication of 70 years ago and offer some conclusions...
Asunto(s)
Humanos , Heridas Penetrantes/cirugía , Heridas Penetrantes/diagnóstico , Lesiones Cardíacas/cirugía , Lesiones Cardíacas/diagnósticoRESUMEN
BACKGROUND: in Mexico, the management of abdominal penetrating trauma doesn't follow the algorithms of Trauma Center level I, because of our limitations, and laparotomies are inevitable in this context. Is possible use some grade of leukocytosis suspect in-trabdominal lesion? METHODS: study retrospective, descriptive and analytic that inclu-ded patients with abdominal penetrating trauma that suffered exploratory laparotomy. We excluded patients' whit severe damage to soft tissues in extremities, thoracic affection, fractures, or da-mage in nervous system. We divided the patients into 2 groups: group I (therapeutic laparotomy) and group II (non-therapeutic laparotomy). Dependent variables were; age, gender, type of injury, number of lesions, peripheral lesions, time between injury and, from a laboaratory blood sample, leukocytosis mean, percentage of neutrophils, leukocytosis ≥ 12,500 /mm(3), and hemoperitoneum. We compared variables between two groups and use Pearson's χ(2) test and T-Student, and percentages as summary of measures. RESULTS: we included 231 patients, group I with 159 patients and group II with 72 patients. Leukocytosis global was 13.2 mil/mm(3) and neutrophil range of 70.3%. 26% of patients did not have leukocytosis at arrival and evaluation, however they were laparotomized because of present peritoneal irritation. Leukocytosis ≥ 12.5 mil/mm(3) was statistically significant in patients with intrabdominal lesions (74.2% vs 27.7%, p < 0.001). CONCLUSIONS: leukocytosis ≥ 12.5 mil/mm(3) could be an early serum marker abdominal penetrating trauma.
Asunto(s)
Traumatismos Abdominales/sangre , Leucocitosis/etiología , Peritoneo/lesiones , Cuidados Preoperatorios , Vísceras/lesiones , Heridas Penetrantes/sangre , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/epidemiología , Traumatismos Abdominales/cirugía , Adolescente , Adulto , Femenino , Hemoperitoneo/epidemiología , Hemoperitoneo/etiología , Humanos , Laparotomía/métodos , Laparotomía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Recuento de Leucocitos , Masculino , México/epidemiología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Triaje , Vísceras/cirugía , Heridas por Arma de Fuego/sangre , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/epidemiología , Heridas Penetrantes/cirugía , Heridas Punzantes/sangre , Heridas Punzantes/diagnóstico , Heridas Punzantes/epidemiología , Heridas Punzantes/cirugía , Adulto JovenRESUMEN
Introducción: los traumatismos penetrantes en la región toracoabdominal presentan un variado espectro de lesiones. El cirujano debe ser capaz de diagnosticar y tratar de forma emergente lesiones de órganos situados en dos cavidades de forma simultánea, e identificar cuál de ellas compromete la vida más rápidamente. Objetivo: caracterizar a los pacientes con herida en la región toracoabdominal. Métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el centro de urgencias del Hospital Militar Central Dr. Carlos J. Finlay. Se analizaron 63 lesionados con diagnóstico de herida toracoabdominal desde enero de 2007 a enero de 2009. Se tuvieron en cuenta las variables: sexo, edad, agente vulnerante, lesiones más frecuentes, así como los procedimientos quirúrgicos realizados. Resultados: predominó el sexo masculino en relación de 4 a 1 y el grupo de edad entre 21 y 30 años. El 84 por ciento de las lesiones fueron ocasionadas por arma blanca. Más de la mitad de los lesionados tenían lesiones en ambas cavidades. El órgano más afectado en el tórax fue el pulmón y en el abdomen el hígado. Los procedimientos quirúrgicos más utilizados fueron la pleurostomía mínima indiferente y la laparotomía exploradora en el 60 por ciento de los casos. La mortalidad fue de 6,4 por ciento y se debió fundamentalmente al shock hipovolémico severo. Conclusiones: los pacientes se caracterizaron por ser fundamentalmente hombres, jóvenes con heridas por arma blanca con afectación pulmonar o hepática que requieren realizar laparotomía exploratoria y tratamiento inmediato del shock hipovolémico(AU)
Introduction: the penetrating traumata in thoracoabdominal region have a varied lesions spectrum. Surgeon must to be able of to diagnose and to treat in an emergent way the lesions of organs located in two cavities at the same time, and to identify which of them compromise faster the life. Objective: to characterize patients with wounds in thoracoabdominal region. Methods: a retrospective, descriptive and observational study was conducted at the center of urgencies of the Dr. Carlos J. Finlay Central Military Hospital. Sixty three patients were analyzed diagnosed with thoracoabdominal wound from January, 2007 to January, 2009. Authors took into account the following variables: sex, age, vulnerant agent, more frequent lesions, as well as the surgical procedures carried out. Results: there was predominance of male sex in a 4:1 ratio and in the 21 and 30 age-groups. The 84 percent of lesions were provoked by blade. More than the half of injured had lesions in both cavities. The more involved organ was the lung and in the abdomen region it was the liver. The more used surgical procedures were an indifferent minimal pleurotomy and the exploratory laparotomy in the 60 percent of cases. Mortality was of 6.4 percent mainly due to severe hypovolemic shock. Conclusions: patients were mostly by young men with wounds by blade and pulmonary or hepatic involvement requiring exploratory laparotomy and immediate treatment of hypovolemic shock(AU)
Asunto(s)
Humanos , Heridas Penetrantes/prevención & control , Heridas Penetrantes/diagnóstico , Traumatismos Torácicos/diagnóstico , Traumatismos Abdominales , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios Observacionales como AsuntoRESUMEN
BACKGROUND: Recent studies report the safety and feasibility of performing delayed anastomosis (DA) in patients undergoing damage control laparotomy (DCL) for destructive colon injuries (DCIs). Despite accumulating experience in both civilian and military trauma, questions regarding how to best identify high-risk patients and minimize the number of anastomosis-associated complications remain. Our current practice is to perform a definitive closure of the colon during DCL, unless there is persistent acidosis, bowel wall edema, or evidence of intra-abdominal abscess. In this study, we evaluated the safety of this approach by comparing outcomes of patients with DCI who underwent definitive closure of the colon during DCL versus patients managed with colostomy with or without DCL. METHODS: We performed a retrospective chart review of patients with penetrating DCI during 2003 to 2009. Severity of injury, surgical management, and clinical outcome were assessed. RESULTS: Sixty patients with severe gunshot wounds and three patients with stab wounds were included in the analysis. DCL was required in 30 patients, all with gunshot wounds. Three patients died within the first 48 hours, three underwent colostomy, and 24 were managed with DA. Thirty-three patients were managed with standard laparotomy: 26 patients with primary anastomosis and 7 with colostomy. Overall mortality rate was 9.5%. Three late deaths occurred in the DCL group, and only one death was associated with an anastomotic leak. CONCLUSIONS: Performing a DA in DCI during DCL is a reliable and feasible approach as long as severe acidosis, bowel wall edema, and/or persistent intra-abdominal infections are not present.
Asunto(s)
Traumatismos Abdominales/cirugía , Anastomosis Quirúrgica/métodos , Colon/lesiones , Laparotomía/métodos , Heridas Penetrantes/cirugía , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/mortalidad , Adulto , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/cirugía , Estudios de Cohortes , Colectomía/efectos adversos , Colectomía/métodos , Colon/cirugía , Colostomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Laparotomía/efectos adversos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/mortalidad , Adulto JovenRESUMEN
Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge to the trauma surgeon due to many factors such as the size of the object, the difficult access, and a close anatomic relationship of the foreign body to vital structures. They are usually a result of injuries or operations. Fragments of broken instruments can be left behind and entire teeth or their fragments can be displaced during extraction. The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit that will provide maintenance of the airways, hemodynamic stabilization, and, but only if necessary, neurologic, ophthalmologic, and vascular evaluation. With a view to illustrating and discussing the diagnosis and treatment of this kind of injury, this study reports impacted foreign bodies in oral and maxillofacial region. The following data were collected: age, sex, race, etiology, occurrence of fracture, anatomic location of the fracture, daytime of the traumatic event, type of the object, signal and symptoms, type of imaging examination used, type of anesthesia, approach, transoperative complication, period between surgery and hospital liberation, and the occurrence of death. Foreign body injuries in the maxillofacial region can place the patient's life at risk, so a correct initial treatment performed by a multidisciplinary team increases the survival of this kind of patient.
Asunto(s)
Cuerpos Extraños/diagnóstico , Traumatismos Maxilofaciales/diagnóstico , Heridas Penetrantes/diagnóstico , Adolescente , Adulto , Factores de Edad , Profilaxis Antibiótica , Lesiones Encefálicas/etiología , Causas de Muerte , Niño , Preescolar , Femenino , Cuerpos Extraños/cirugía , Hemostasis Quirúrgica , Humanos , Enfermedad Iatrogénica , Masculino , Traumatismos Maxilofaciales/cirugía , Persona de Mediana Edad , Planificación de Atención al Paciente , Grupo de Atención al Paciente , Premedicación , Estudios Retrospectivos , Factores Sexuales , Fracturas Craneales/diagnóstico , Fracturas Craneales/cirugía , Toxoide Tetánico/administración & dosificación , Heridas Penetrantes/cirugía , Adulto JovenRESUMEN
Foreign bodies, although they are often found throughout the body, to a lesser degree in the face, still constitute a diagnostic challenge for the trauma surgeon. Its removal means danger of damaging important facial anatomic structures, even if its exact position from the image data was known. So, the objective is to describe a clinical report of a patient (42 years of age, male sex) who experienced falling to the ground, attended by the Department of Surgery and Traumatology Bucco-Maxillo-Facial Surgery, Faculty of Dentistry of Araçatuba, São Paulo State University, and 2 days after the trauma, he reported difficulty in mouth opening and pain. After clinical evaluation, we observed the presence of injury in the left preauricular region already in the process of healing. During the intraoral physical examination, a limitation of the mouth opening was noted. Radiographic posteroanterior and profile of the face showed 2 radiopaque foreign bodies in the left side, lying apparently at the region of the mandibular condylar process. Under local anesthesia, foreign body removal was carried from there with access to it through the preexisting facial injury. Further clinical examinations showed an improvement in mouth opening, absence of pain complaints, and/or functional complaints.
Asunto(s)
Cuerpos Extraños/diagnóstico , Cóndilo Mandibular , Accidentes por Caídas , Adulto , Estudios de Seguimiento , Cuerpos Extraños/cirugía , Humanos , Masculino , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Rango del Movimiento Articular/fisiología , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugíaRESUMEN
The aim of the present study was to describe and discuss the gamut of current diagnostic and therapeutic modalities regarding impacted foreign bodies in the head and neck region, addressing xeroradiography, magnetic resonance imaging, computed tomography, and ultrasonography as diagnostic aids and stressing the importance of a multidisciplinary team in the treatment of such injuries. Considerations are also offered on the different types and forms of presentation of foreign bodies that may be impacted in the maxillofacial region and specific treatment methods.
Asunto(s)
Cuerpos Extraños/diagnóstico , Traumatismos Maxilofaciales/diagnóstico , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/cirugía , Cuerpos Extraños/cirugía , Humanos , Imagen por Resonancia Magnética , Traumatismos Maxilofaciales/cirugía , Tomografía Computarizada por Rayos X , Ultrasonografía , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugía , XerorradiografíaRESUMEN
This is a revision based in a personal experience of the penetrating wounds of the neck, describing the diagnosis and treatment.