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Current Drug Targets 2020Chronic non-healing wounds are estimated to cost the US healthcare $28-$31 billion per year. Diabetic ulcers, arterial and venous ulcers, and pressure ulcers are some of... (Review)
Review
Chronic non-healing wounds are estimated to cost the US healthcare $28-$31 billion per year. Diabetic ulcers, arterial and venous ulcers, and pressure ulcers are some of the most common types of chronic wounds. The burden of chronic wounds continues to rise due to the current epidemic of obesity and diabetes and the increase in elderly adults in the population who are more vulnerable to chronic wounds than younger individuals. This patient population is also highly vulnerable to debilitating infections caused by opportunistic and multi-drug resistant pathogens. Reduced microcirculation, decreased availability of cytokines and growth factors that promote wound closure and healing, and infections by multi-drug resistant and biofilm forming microbes are some of the critical factors that contribute to the development of chronic non-healing wounds. This review discusses novel approaches to understand chronic wound pathology and methods to improve chronic wound care, particularly when chronic wounds are infected by multi-drug resistant, biofilm forming microbes.
Topics: Animals; Biofilms; Chronic Disease; Drug Resistance, Bacterial; Humans; Wound Healing; Wounds and Injuries
PubMed: 32576127
DOI: 10.2174/1389450121666200623131200 -
Journal of Vascular Surgery. Venous and... Mar 2021Published outcomes on anterior lumbar interbody fusion (ALIF) have focused on 1-2 level fusion with and without vascular surgery assistance. We examined the influence of... (Comparative Study)
Comparative Study
BACKGROUND
Published outcomes on anterior lumbar interbody fusion (ALIF) have focused on 1-2 level fusion with and without vascular surgery assistance. We examined the influence of multilevel fusion on exposure-related outcomes when performed by vascular surgeons.
METHODS
We retrospectively reviewed clinical and radiographic data for patients undergoing anterior lumbar interbody fusion (ALIF) with exposure performed by vascular surgeons at a single practice.
RESULTS
From 2017-2018, 201 consecutive patients underwent vascular-assisted ALIF. Patients were divided by number of vertebral levels exposed (90 patients with 1 level exposed, 71 with 2, 40 with 3+). Demographically, 3+ level fusion patients were older (P=.0045) and more likely to have had prior ALIF (P=.0383). Increased vertebral exposure was associated with higher rates of venous injury (P=.0251), increased procedural time (P= .0116), length of stay (P=.0001), and incidence of postoperative DVT (P=.0032). There was a 6.5% rate of intraoperative vascular injury, comprised of 3 major and 10 minor venous injuries. In patients who experienced complications, 92.3% of injuries were repaired primarily. 23% of patients with venous injuries developed postoperative deep venous thrombosis. In a multivariate logistic regression model, increased levels of exposure (RR = 6.23, P = .026) and a history of degenerative spinal disease (RR = .033, P = .033) were predictive of intraoperative venous injury.
CONCLUSIONS
Increased vertebral exposure in anterior lumbar interbody fusion is associated with increased risk of intraoperative venous injury and postoperative deep venous thrombosis, with subsequently greater lengths of procedure time and length of stay. Rates of arterial and sympathetic injury were not affected by exposure extent.
Topics: Aged; Female; Humans; Length of Stay; Lumbar Vertebrae; Male; Middle Aged; Operative Time; Retrospective Studies; Risk Assessment; Risk Factors; Spinal Fusion; Time Factors; Treatment Outcome; Vascular System Injuries; Veins; Venous Thrombosis
PubMed: 32795618
DOI: 10.1016/j.jvsv.2020.08.006 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jan 2020
Topics: Bites and Stings; Cerebral Angiography; Child, Preschool; Craniocerebral Trauma; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Occipital Bone; Tomography, X-Ray Computed; Transverse Sinuses; Wounds, Penetrating
PubMed: 31537022
DOI: 10.1055/a-0969-2210 -
The Journal of Thoracic and... May 2020
Topics: Coronary Occlusion; Coronary Vessels; Heart Defects, Congenital; Heart Injuries; Humans
PubMed: 31982121
DOI: 10.1016/j.jtcvs.2019.11.027 -
La Revue de Medecine Interne May 2020
Topics: Adult; Aneurysm; Anticoagulants; Athletic Injuries; Diagnosis, Differential; Edema; Humans; Jugular Veins; Male; Neck; Neck Injuries; Neck Pain; Venous Thrombosis
PubMed: 31662231
DOI: 10.1016/j.revmed.2019.09.004 -
Scandinavian Journal of Trauma,... Dec 2022Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce.
BACKGROUND
Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce.
METHODS
A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009-2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan-Meier) estimated.
RESULTS
Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13-1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury.
CONCLUSIONS
Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Adult; Male; Humans; Female; Vascular System Injuries; Trauma Centers; Retrospective Studies; Injury Severity Score; Wounds, Penetrating; Treatment Outcome
PubMed: 36544205
DOI: 10.1186/s13049-022-01059-5 -
American Journal of Surgery Jan 2020Major venous injury (MVI) affecting the lower extremity can result in subsequent amputation. The contribution of intraoperative resuscitation efforts on the need for... (Comparative Study)
Comparative Study
INTRODUCTION
Major venous injury (MVI) affecting the lower extremity can result in subsequent amputation. The contribution of intraoperative resuscitation efforts on the need for amputation is not well defined. We hypothesized that intraoperative large volume crystalloid resuscitation (LVCR) increases the risk of amputation after MVI, while massive transfusion (MT) does not.
METHODS
We performed a retrospective review of patients with infrarenal MVI from 2005 to 2015 at seven urban level I trauma centers. The outcome of interest was the need for secondary amputation.
RESULTS
478 patients were included. 31 (6.5%) patients with MVI required amputation. LVCR(p < 0.001), combined arterial/venous injury (p = 0.001), and associated fracture (p = 0.001) were significant risk factors for amputation. MT did not significantly increase amputation risk (p = 0.44). Multivariable logistic regression model demonstrated that patients receiving ≥5L LVCR(aOR (95% CI): 9.7 (2.9, 33.0); p < 0.001), with combined arterial/venous injury (aOR (95% CI):3.6 (1.5, 8.5); p = 0.004), and with an associated fracture (aOR (95% CI):3.2 (1.5, 7.1); p = 0.004) were more likely to require amputation.
CONCLUSION
Patients with MVI who receive LVCR, have combined arterial/venous injuries and have associated fractures are more likely to require amputation. MT was not associated with delayed amputation.
Topics: Adult; Amputation, Surgical; Blood Transfusion; Crystalloid Solutions; Female; Humans; Injury Severity Score; Intraoperative Care; Leg; Male; Resuscitation; Retrospective Studies; Risk Assessment; Veins; Young Adult
PubMed: 31604488
DOI: 10.1016/j.amjsurg.2019.10.011 -
Journal of Ayub Medical College,... 2022Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We...
Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We present a case of a fortunate survivor who had complete transection of left anterior descending (LAD) artery with right ventricular (RV) tear after being stabbed by knife, arriving in emergency unit with massively bleeding chest wound. Complex cardiac trauma involving coronaries and cardiac chambers is a challenge to surgeons if patients miraculously reach the hospital alive. This patient had complete transection of LAD artery with penetration into RV cavity, he was successfully managed by timely and prompt surgical intervention by on call team. This case highlights the importance of team dynamics working in harmony during emergency situations, we stress upon conducting routine drills to train surgical residents, perfusionists and operation theatre staff.
Topics: Male; Humans; Wounds, Stab; Wounds, Penetrating; Thoracic Injuries; Heart Injuries; Coronary Vessels
PubMed: 36550672
DOI: 10.55519/JAMC-04-S4-10328 -
The Journal of Bone and Joint Surgery.... Mar 2022
Topics: Anticoagulants; Humans; Risk Factors; Trauma Centers; Venous Thromboembolism; Wounds and Injuries
PubMed: 35315615
DOI: 10.2106/JBJS.21.01476 -
Vascular and Endovascular Surgery Aug 2023Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting... (Review)
Review
OBJECTIVE
Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique.
METHODS
A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy.
RESULTS
The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period.
CONCLUSIONS
Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described.
Topics: Male; Humans; Vena Cava, Inferior; Iliac Vein; Endovascular Procedures; Treatment Outcome; Vascular System Injuries; Abdominal Injuries; Stents; Iatrogenic Disease; Retrospective Studies
PubMed: 36920124
DOI: 10.1177/15385744231163964