Near Disappearance of Splenorrhaphy as an Operative Strategy for Splenic Preservation After Trauma.

BACKGROUND: Splenorrhaphy was once used to achieve splenic preservation in up to 40% of splenic injuries. With increasing use of nonoperative management and angioembolization, operative therapy is less common and splenic injuries treated operatively are usually high grade. Patients are often unstable, making splenic salvage unwise. Modern surgeons may no longer possess the knowledge to perform splenorrhaphy. METHODS: The records of adult trauma patients with splenic injuries from September 2014 to November 2018 at an urban level I trauma center were reviewed retrospectively. Data including American Association for the Surgery of Trauma splenic organ injury scale, type of intervention, splenorrhaphy technique, and need for delayed splenectomy were collected. This contemporary cohort (CC) was compared to a historical cohort (HC) of splenic injuries at a single center from 1980 to 1989 (Ann Surg 1990; 211: 369). RESULTS: From 2014 to 2018, 717 adult patients had splenic injuries. Initial management included 157 (21.9%) emergent splenectomy, 158 (22.0%) angiogram ± embolization, 371 (51.7%) observation, and only 10 (1.4%) splenorrhaphy. The HC included a total of 553 splenic injuries, of which 313 (56.6%) underwent splenectomy, while splenorrhaphy was performed in 240 (43.4%). Those who underwent splenorrhaphy in each cohort (CC vs HC) were compared. CONCLUSION: The success rate of splenorrhaphy has not changed. However, splenorrhaphy now involves only electrocautery with topical hemostatic agents and is used primarily in low-grade injuries. Suture repair and partial splenectomy seem to be "lost arts" in modern trauma care.

Damage control in penetrating duodenal trauma: less is better - the sequel.

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".

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

El trauma de las vísceras huecas representa una gran proporción de las lesiones asociadas al trauma penetrante. Actualmente, las lesiones aisladas de intestino delgado o colon se manejan a través de anastomosis primaria en pacientes sometidos a laparotomía definitiva o anastomosis diferida en pacientes que requieran cirugía de control de daños. El dogma quirúrgico tradicional de la ostomía se ha probado que es innecesario y en muchos casos puede aumentar la morbilidad. El objetivo de este artículo es describir la experiencia obtenida en el manejo de lesiones combinadas de vísceras huecas de pacientes con trauma penetrante. Se determinó que el manejo primario o diferido del intestino a través de anastomosis es el abordaje quirúrgico preferido en pacientes que presentan lesiones penetrantes combinadas de intestino delgado y colon. Se ha reportado que el 90% de lesiones combinadas penetrantes intestinales pueden ser manejadas a través de anastomosis primaria o diferida incluso en los casos más severos requieren la aplicación de los principios de control de daños. Aplicando esta estrategia, la tasa general para ostomía (primaria o diferida) puede ser reducida a menos del 10%.

Damage Control for renal trauma: the more conservative the surgeon, better for the kidney.

Urologic trauma is frequently reported in patients with penetrating trauma. Currently, the computerized tomography and vascular approach through angiography/embolization are the standard approaches for renal trauma. However, the management of renal or urinary tract trauma in a patient with hemodynamic instability and criteria for emergency laparotomy, is a topic of discussion. This article presents the consensus of the Trauma and Emergency Surgery Group (CTE) from Cali, for the management of penetrating renal and urinary tract trauma through damage control surgery. Intrasurgical perirenal hematoma characteristics, such as if it is expanding or actively bleeding, can be reference for deciding whether a conservative approach with subsequent radiological studies is possible. However, if there is evidence of severe kidney trauma, surgical exploration is mandatory and entails a high probability of requiring a nephrectomy. Urinary tract damage control should be conservative and deferred, because this type of trauma does not represent a risk in acute trauma management.

El trauma renal y de las vías urinarias se presenta con relativa frecuencia en pacientes con trauma penetrante. El estándar actual de manejo es realizar una evaluación imagenológica, por medio de tomografía computarizada y un abordaje vascular, a través de técnicas de angiografía/embolización. Sin embargo, el manejo de un paciente hemodinámicamente inestable con criterios de laparotomía de emergencia, con hallazgos de trauma renal o de vías urinarias es aún tema de discusión. El siguiente articulo presenta el consenso del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali respecto al manejo del trauma penetrante renal y de vías urinarias mediante cirugía de control de daños. Las características intra quirúrgicas del hematoma perirrenal tales como si es expansivo o si tiene signos de sangrado activo, son puntos de referencia para decidir entre un abordaje conservador, por estudios imagenológicos posteriores. En cambio, si existe la sospecha de un trauma renal severo, se debe realizar exploración quirúrgica con alta probabilidad de una nefrectomía. El manejo de control de daños de las vías urinarias debe ser conservador y diferido, la lesión de estos órganos no representa un riesgo en el manejo agudo del trauma.

Is it time for firearm injury to be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence.

BACKGROUND: Penetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality. METHODS: Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups. RESULTS: A total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. CONCLUSION: There is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury.

Injury patterns and causes of death in 953 patients with penetrating abdominal war wounds in a civilian independent non-governmental organization hospital in Lashkargah, Afghanistan.

Background: Management of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control. A civilian hospital based in a war zone can rarely rely upon these principles because it normally has limited resources and lacks rapid medical evacuation. We designed this study to describe organ injury patterns and factors related to mortality in patients with penetrating abdominal war injuries in a civilian hospital in an active war zone in Afghanistan, examine how these findings differ from those in a typical military setting, and evaluate how they might improve patients' care. Methods: We reviewed the records of all patients admitted at the Lashkargah "Emergency" hospital with penetrating abdominal injuries treated from January 2006 to December 2016. Demographic and clinical data were recorded; univariate and multivariate analyses were used to identify variables significantly associated with death. Results: We treated 953 patients for penetrating abdominal injury. The population was mainly civilian (12.1% women and 21% under 14). Mean age was 23 years, and patients with blast injuries were younger than in the other groups. The mechanism of injury was bullet injury in 589 patients, shell injury in 246, stab wound in 97, and mine injury in 21. The most frequent abdominal lesion was small bowel injury (46.3%). Small and large bowel injuries were the most frequent in the blast groups, stomach injury in stab wounds. Overall mortality was 12.8%. Variables significantly associated with death were age > 34 years, mine and bullet injury, length of stay, time since injury > 5 h, injury severity score > 17, and associated injuries. Conclusions: Epidemiology and patterns of injury in a civilian hospital differ from those reported in a typical military setting. Our population is mainly civilian with a significant number of women and patients under 14 years. BI are more frequent than blast injuries, and gastrointestinal injuries are more common than injuries to solid organs. In this austere setting, surgeons need to acquire a wide range of skills from multiple surgical specialties. These findings might guide trauma and general surgeons treating penetrating abdominal war wounds to achieve better care and outcome.

Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians.

PURPOSE: The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians. PATIENTS AND METHODS: The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients' data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients' data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score. RESULTS: MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ±â€Š12). Eighty-two percent or higher rates of the injuries needed >4 days' hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions. CONCLUSIONS: Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.

Injuries to amateur participants in traditional bullfighting festivals. / Lesiones producidas en aficionados durante los festejos taurinos populares.

INTRODUCTION: To identify the different types of injuries occurred during activities for the general public involving bulls. We analyze the conditions in which these injuries occurred, radiological examinations performed, treatment and complications. METHOD: We present a 10-year retrospective study examining 107 patients who came to the Emergency Department of our hospital with pathologies associated with bulls or bull calves over a period of 10years. We evaluated patient age and sex, exposure to toxic substances, period of the year in which the lesions occurred, type of injury (open, closed or mixed lesions), hospital stay, transfer to another hospital, treatment and complications. RESULTS: A total of 107 patients (98 males and 9 females), with a mean age of 41.68years, were treated for injuries in popular bull festivals. 77.57% of the injuries occurred during the months of July, August and September. 95 out of the 107 patients (88.78%) were hospitalized. The total number of injuries included: 91 open wounds, 10 bruises, 27 fractures and 5 traumatic brain injuries. 83 injuries (62.40%) affected the lower limbs and perineum. The treatment received was: suture (2), Friedreich (69), hematoma drainage (1), orthopedic surgery (5), exploratory laparotomy (6) and neurosurgery (1). Two patients died. CONCLUSIONS: Injuries occurring during traditional bull-related festivals are different in patients with open wounds from patients who suffer blunt trauma. The pathogenesis of these injuries must be understood in order to improve patient survival.

An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?

INTRODUCTION: Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies. METHODS: We created a multicenter, pancreatic trauma registry from 18 Level 1 and 2 trauma centers. Adult, blunt or penetrating injured patients from 2005 to 2012 were analyzed. Sensitivity and specificity of CT scan identification of main pancreatic duct injury was calculated against operative findings. Independent predictors for mortality, adult respiratory distress syndrome (ARDS), and pancreatic fistula and/or pseudocyst were identified through multivariate regression analysis. The association between outcomes and operative management was measured. RESULTS: We identified 704 pancreatic injury patients of whom 584 (83%) underwent a pancreas-related procedure. CT grade modestly correlated with OR grade (r 0.39) missing 10 ductal injuries (9 grade III, 1 grade IV) providing 78.7% sensitivity and 61.6% specificity. Independent predictors of mortality were age, Injury Severity Score (ISS), lactate, and number of packed red blood cells transfused. Independent predictors of ARDS were ISS, Glasgow Coma Scale score, and pancreatic fistula (OR 5.2, 2.6-10.1). Among grade III injuries (n = 158, 22.4%), the risk of pancreatic fistula/pseudocyst was reduced when the end of the pancreas was stapled (OR 0.21, 95% CI 0.05-0.9) compared with sewn and was not affected by duct stitch placement. Drainage alone in grades IV (n = 25) and V (n = 24) injuries carried increased risk of pancreatic fistula/pseudocyst (OR 8.3, 95% CI 2.2-32.9). CONCLUSION: CT is insufficiently sensitive to reliably identify pancreatic duct injury. Patients with grade III injuries should have their resection site stapled instead of sewn and a duct stitch is unnecessary. Further study is needed to determine if drainage alone should be employed in grades IV and V injuries. LEVEL OF EVIDENCE: Epidemiologic/Diagnostic study, level III.

Características clínicas del trauma vascular periférico en pacientes atendidos en el Hospital Escuela Universitario, Honduras / Clinical Characteristics of Peripheral Vascular Trauma patients treated at the University Hospital Escuela, Honduras

Objetivo: Describir las características clínicas de los Trauma Vascular Periférico en pacientes atendidos en el Hospital Escuela Universitario. Metodología: Estudio descriptivo, retrospectivo incluyendo a todos los pacientes atendidos en el Hospital desde 01 de febrero de 2014 hasta el 28 de febrero de 2015. La información se obtuvo de las historias clínicas. Resultados: Se encontraron 21 pacientes con trauma vascular periférico, de los cuales el 100% pertenecen al sexo masculino, la edad frecuentemente afectada es entre los 20 a 29 años 38.1 %. El tipo de trauma encontrado fue trauma abierto en un 100%. La causa de lesión vascular más frecuente fue la agresión 66.67%. Los mecanismos de lesión encontrados fueron: herida por arma de fuego 76.19%, herida por arma blanca 19.05% e iatrogénico en un paciente 4.76%. Los miembros inferiores fueron la parte más afectada con un 52.38%. No hubo mortalidad. Conclusión: Las heridas por traumas vasculares periféricos son cada vez más frecuentes en nuestro medio y el diagnóstico y tratamiento no es difícil en la mayoría de los casos...(AU)

[Ocular Trauma Score comparison with open globe receiving early or late care attention]. / Comparación del Ocular Trauma Score en traumatismo con globo abierto, atendido temprana o tardíamente.

BACKGROUND: The Ocular Trauma Score (OTS) is a scale that estimates the prognosis of injured eyes after treatment, whose results are consistent with those of longitudinal studies. The time between injury presentation and initial care has been described as a prognostic factor for visual outcome, but the OTS features of eyes receiving early or late care after trauma have not been compared. MATERIAL AND METHODS: Non-experimental, comparative, retrospective, cross sectional study. Patients from either gender, aged 5-80 years, with open globe trauma, without previous diseases that reduced visual acuity or previous intraocular surgery were included. The distribution of the OTS variables was identified. The sample was divided in two: group 1 (time between trauma occurrence and initial care ≤ 24 hours) and 2 (time > 24 hours). The frequency of OTS categories of unfavorable prognosis (1-3) was compared between groups (χ(2)). RESULTS: 138 eyes of 138 patients, mean age 28.8 years, 65.2% male. The evolution time ranged 2-480 hours (mean 39.9); 103 eyes were assigned to group 1 (74.6%), and 35 to group 2 (25.4%). The proportion of categories 1-3 in group 1 (82.5%, n = 85) did not differ from that in group 2 (80%, n = 28; p = 1.0). CONCLUSION: The proportion of OTS categories with unfavorable prognosis did not show significant differences between the eyes who received care before or after 24 hours that could contribute to a different outcome, besides the delay in starting treatment.

Update in the classification and treatment of complex renal injuries.

The "Evidence-Based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma defined as American Association for the Surgery of Trauma (AAST) injury grade III-V. The first paper was the proposal for the AAST grade 4renal injury substratification into grades 4a (Low Risk) and 4b (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

Combat injury coding: a review and reconfiguration.

BACKGROUND: The current civilian Abbreviated Injury Scale (AIS), designed for automobile crash injuries, yields important information about civilian injuries. It has been recognized for some time, however, that both the AIS and AIS-based scores such as the Injury Severity Score (ISS) are inadequate for describing penetrating injuries, especially those sustained in combat. Existing injury coding systems do not adequately describe (they actually exclude) combat injuries such as the devastating multi-mechanistic injuries resulting from attacks with improvised explosive devices (IEDs). METHODS: After quantifying the inapplicability of current coding systems, the Military Combat Injury Scale (MCIS), which includes injury descriptors that accurately characterize combat anatomic injury, and the Military Functional Incapacity Scale (MFIS), which indicates immediate tactical functional impairment, were developed by a large tri-service military and civilian group of combat trauma subject-matter experts. Assignment of MCIS severity levels was based on urgency, level of care needed, and risk of death from each individual injury. The MFIS was developed based on the casualty's ability to shoot, move, and communicate, and comprises four levels ranging from "Able to continue mission" to "Lost to military." Separate functional impairments were identified for injuries aboard ship. Preliminary evaluation of MCIS discrimination, calibration, and casualty disposition was performed on 992 combat-injured patients using two modeling processes. RESULTS: Based on combat casualty data, the MCIS is a new, simpler, comprehensive severity scale with 269 codes (vs. 1999 in AIS) that specifically characterize and distinguish the many unique injuries encountered in combat. The MCIS integrates with the MFIS, which associates immediate combat functional impairment with minor and moderate-severity injuries. Predictive validation on combat datasets shows improved performance over AIS-based tools in addition to improved face, construct, and content validity and coding inter-rater reliability. Thus, the MCIS has greater relevance, accuracy, and precision for many military-specific applications. CONCLUSION: Over a period of several years, the Military Combat Injury Scale and Military Functional Incapacity Scale were developed, tested and validated by teams of civilian and tri-service military expertise. MCIS shows significant promise in documenting the nature, severity and complexity of modern combat injury.

Atualização da classificação e tratamento das lesões renais complexas / Update in the classification and treatment of complex renal injuries

A reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) realizou uma revisão crítica da literatura e selecionou três artigos atuais sobre o tratamento do trauma renaldefinido como graus III a V pela classificação da Associação Americana de Cirurgia do Trauma (AAST). O primeiro trabalho propõe subestratificação da lesão renal AAST grau IV em 4a (baixo risco) e 4b (alto risco). O segundo trabalho revisa o atual sistema de classificação de lesão renal AASTpara incluir lesões vasculares segmentares e estabelecer uma definição mais detalhada dos graus IV e V. O último artigo analisa a angiografia diagnóstica e angioembolização na fase aguda do trauma renal utilizando dados americanos. A reunião de revista TBE-CiTE elaborou as conclusões e recomendações para o tratamento do trauma renal de alto grau.

The "Evidence-Based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma defined as American Association for the Surgery of Trauma (AAST) injury grade III-V. The first paper was the proposal for the AAST grade 4renal injury substratification into grades 4a (Low Risk) and 4b (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a nationaldata set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

Developmental framework to validate future designs of ballistic neck protection.

The number of neck injuries has increased during the war in Afghanistan, and they have become an appreciable source of mortality and long-term morbidity for UK servicemen. A three-dimensional numerical model of the neck is necessary to allow simulation of penetrating injury from explosive fragments so that the design of body armour can be optimal, and a framework is required to validate and describe the individual components of this program. An interdisciplinary consensus group consisting of military maxillofacial surgeons, and biomedical, physical, and material scientists was convened to generate the components of the framework, and as a result it incorporates the following components: analysis of deaths and long-term morbidity, assessment of critical cervical structures for incorporation into the model, characterisation of explosive fragments, evaluation of the material of which the body armour is made, and mapping of the entry sites of fragments. The resulting numerical model will simulate the wound tract produced by fragments of differing masses and velocities, and illustrate the effects of temporary cavities on cervical neurovascular structures. Using this framework, a new shirt to be worn under body armour that incorporates ballistic cervical protection has been developed for use in Afghanistan. New designs of the collar validated by human factors and assessment of coverage are currently being incorporated into early versions of the numerical model. The aim of this paper is to describe this developmental framework and provide an update on the current progress of its individual components.

Revision of current American Association for the Surgery of Trauma Renal Injury grading system.

BACKGROUND: We propose a revision of the original 1989 renal organ injury system established by the American Association for the Surgery of Trauma based on our institution's>25-year longitudinal experience. Our goal is to expand the current grading system to include segmental vascular injuries and ureteral pelvic injuries and to establish a more rigorous definition of severe grade IV and V renal injuries. METHODS: We retrospectively reviewed our prospectively gathered contiguous renal database of 3,580 renal injuries to describe a revised renal grading injury scale based on clinical renal salvage outcomes. We focused on the mechanism of injury, the stability of the patient, radiographic imaging, associated nonrenal injuries, and clinical salvage outcome data. RESULTS: No changes were made in the definition of grade I to III injuries. The revised grade IV classification includes all collecting system, renal pelvis injuries and segmental arterial and/or venous injuries. The revised grade V classification is limited to main renal artery and/or vein injuries, including laceration, avulsion, and thrombosis. We compared the nephrectomy rate and clinical renal salvage rate between the original 1989 renal organ injury system with our revised renal injury staging classification. CONCLUSION: The revised renal injury staging classification provides complete and clear definitions of renal trauma while still performing its fundamental objective to reflect increasingly complex renal injuries. Uniform language and classification of renal injuries will enhance discussion, clinical investigation, and research of renal trauma.

DASH and sollerman test scores after hand injury from powered wood splitters.

The purpose of the study was to describe the outcome after hand injury from powered wood splitters, and to investigate the relation between injury severity and outcome. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score method. The patients were evaluated with the Disabilities of the Arm Shoulder and Hand outcome questionnaire (DASH), and 26 of the most severely injured patients were evaluated with the Sollerman test. The mean DASH score was moderately elevated at 15, indicating that many of these patients have sequelae. A statistically significant correlation between HISS and DASH scores was found, implying that initial injury severity is of importance for outcome. The mean Sollerman score in the injured hand was 66, which amounts to a significantly impaired hand function.

Monitoring the healing of combat wounds using Raman spectroscopic mapping.

Soldiers wounded in modern warfare present with extensive and complicated acute wounds, confounded by an overwhelming inflammatory response. The pathophysiology of acute wounds is unknown and timing of wound closure remains subjective. Collagen gene expression profiles are presented for 24 patients. Impaired healing wounds showed a twofold decrease in the up-regulation of COL1A1 and COL3A1 genes in the beginning of the wound healing process, compared with normal healing wounds. By the final debridement, however, collagen gene expression profiles for normal and impaired healing wounds were similar for COL1A1 and COL3A1. In addition, Raman spectroscopic maps were collected of biopsy tissue sections, from the first and last debridements of 10 wounds collected from nine patients. Tissue components obtained for the debridement biopsies were compared to elucidate whether or not a wound healed normally. Raman spectroscopy showed a loss of collagen in five patients, indicated by a negative percent difference in the 1,665/1,445 cm(-1) band area ratios. Four healed patients showed an increased or unchanged collagen content. Here, we demonstrate the potential of Raman spectroscopic analysis of wound biopsies for classification of wounds as normal or impaired healing. Raman spectroscopy has the potential to noninvasively monitor collagen deposition in the wound bed, during surgical wound debridements, to help determine the optimal time for wound closure.