Case report: Endovascular stent-graft repair of aortic penetrating trauma, literature review, and case report.

Penetrating aortic injuries are infrequent. Its incidence is unknown because most patients die of hemorrhage even before they receive adequate treatment. Aortic wounds generally require conventional thoracotomy/laparotomy repair and are related to high mortality rates. Recently with the advent of endovascular techniques, most authors prefer endovascular management when feasible due to better (still poor) outcomes. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Here we present the diagnosis and treatment of a 30 years-old male patient with multiple traumatic stab wounds, including anterior aortic laceration with a grade II aortic lesion successfully managed with an endovascular stent graft.

Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial.

BACKGROUND: Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control. METHODS: Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL. RESULTS: The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001). CONCLUSION: This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).

Reconstrucción de estenosis traqueal benigna: experiencia de un hospital de alta complejidad en Colombia / Reconstruction of benign tracheal stenosis: Experience of a high-level complexity hospital in Colombia

Introducción. La causa más común de estenosis laringotraqueal benigna es iatrogénica, secundaria a intubación orotraqueal. El manejo quirúrgico sigue siendo la alternativa que ha mostrado mejores resultados a largo plazo. El objetivo de este estudio fue analizar la experiencia en el manejo quirúrgico de la estenosis laringotraqueal durante 15 años en un hospital de alta complejidad en Colombia.Métodos. En este estudio se revisaron las historias clínicas de todos los pacientes tratados con reconstrucción de estenosis traqueal benigna, entre los años 2005 y 2020. Para el análisis estadístico se usaron métodos de estadística descriptiva, con análisis de frecuencias y medidas de tendencia central o de dispersión.Resultados. Se identificaron 38 pacientes con estenosis laringotraqueal, con un grado variable de estenosis. La nasofibrolaringoscopia fue bien tolerada y segura para determinar el grado y la longitud de la estenosis. El uso de tomografía sirvió para determinar la extensión y las características anatómicas. Los resultados del presente estudio son similares a los de la literatura en cuanto a complicaciones, mortalidad y falla de la anastomosis. Las complicaciones más frecuentemente reportadas son reestenosis, infección del sitio operatorio, lesión nerviosa y fístula, que en general se presentan en un tercio de los pacientes. Conclusiones. La experiencia de manejo quirúrgico de estenosis laringotraqueal en este hospital permite concluir que la reconstrucción traqueal es una opción segura en nuestro medio. Las tasas de éxito y de falla del tratamiento son equiparables a las reportadas en la literatura.

Introduction. The most common cause of benign laryngotracheal stenosis is iatrogenic, secondary to orotracheal intubation. Surgical management continues to be the alternative that has shown better long-term results. The objective of this study was to analyze the experience in the surgical management of laryngotracheal stenosis for 15 years in a high-level complexity hospital in Colombia.Methods. Medical records of patients treated with reconstruction of benign tracheal stenosis between 2005 and 2020 were reviewed. Descriptive statistical methods were used, with frequency analysis and measures of central tendency or dispersion.Results. Thirthy-eight patients with laryngotracheal stenosis were identified, with a variable degree of stenosis. Nasofibrolaryngoscopy was well tolerated and safe to determine the degree and length of the stenosis. The use of tomography served to determine the extension and anatomical characteristics. The results of the present study are similar to those of the literature in terms of complications, mortality and failure of the anastomosis. The most frequently reported complications are restenosis, surgical site infection, nerve injury, and fistula, which generally occur in one third of patients.Conclusions. The experience of surgical management of laryngotracheal stenosis in our hospital allows us to conclude that tracheal reconstruction is a safe option in our environment. Treatment success and failure rates are comparable to those reported in the literature.

A clinical series of packing the wound tract for arresting traumatic hemorrhage from injuries of the lung parenchyma as a feasible damage control technique.

Background: Tractotomy has become the standard of care for transfixing through-and-through lung injuries as it can be performed quickly with little blood loss and a low risk of complications. However, packing with laparotomy pads could be a feasible alternative to tractotomy on selected patients. We describe a series of four patients with lung trauma in which packing of the pulmonary wound tract was used as the primary and unique surgical strategy for arresting hemorrhage from injuries of the lung parenchyma. Methods: Packing of the traumatic tract is achieved by gently pulling a laparotomy pad with a Rochester clamp and adjusting it to the cavity to stop the bleeding. The pack is removed in a subsequent surgery by moistening and tractioning it softly to avoid additional damage. The operation is completed by manual compression of the wounded lobe. We present a case series of our experience with this approach. Results: From 2012 to 2016, we treated four patients with the described method. The mechanism was penetrating in all them. The clinical condition was of exsanguinations with multiple sources of hemorrhage. There were three patients with peripheral injuries to the lung and one with a central injury to the pulmonary parenchyma. Bleeding was stopped in all the cases. Three patients survived. A patient had recurrent pneumothorax which was resolved with a second chest tube. Conclusion: Packing of the traumatic tract allowed rapid and safe treatment of transfixing through-and-through pulmonary wounds in exsanguinating patients under damage control from several bleeding sources.

Flebitis asociada con accesos venosos periféricos en niños: revisión sistemática de la literatura / Peripheral venous catheter associated phlebitis in children: A systematic review

Objetivo: Realizar una revisión sistemática de la literatura sobre la aparición de flebitis en niños, relacionada con catéteres venosos periféricos cortos. Metodología: Se buscó en las bases de datos PubMed, Scopus y Scielo, con los términos libres catéter venoso, infección, flebitis y sinónimos, sin límite de idioma, publicados en los últimos 10 años (desde las recomendaciones del CDC). Resultados: De un total inicial de 1.486 referencias, se seleccionaron 9 artículos que midieran la frecuencia de flebitis y su relación con el tiempo de permanencia del catéter. Estos fueron realizados en poblaciones heterogéneas, con diferentes definiciones de flebitis, y distintos desenlaces de interés; el tiempo de aparición de flebitis fue un desenlace secundario en todos. Discusión: A diferencia de los adultos, en niños no hay estudios encaminados a evaluar el tiempo adecuado de permanencia del catéter venoso periférico corto. Se requiere más investigación en este campo.

Objective: To carry out a systematic review of the literature on the occurrence of phlebitis related to short peripheral venous catheters in children. Methodology: We searched PubMed, Scopus and Scielo databases using venous catheter, infection, phlebitis and synonyms as free terms, no language restriction, in the last 10 years (since the CDC made its recommendations). Results: From an initial total of 1486 references, 9 measured the frequency of phlebitis and its relationship to the time of catheter placement. These studies were performed on heterogeneous populations, with varying definitions of phlebitis and various outcomes of interest. The time of occurrence of phlebitis was always a secondary endpoint. Discussion: Unlike adults, in children there are no studies assessing the appropriate amount oftime to maintain a short peripheral venous catheter. More research is needed in this field.