Zaza Demetrashvili
Tbilisi State Medical University Georgia
Title: Damage Control Surgery in Abdominal Trauma
Biography
Zaza Demetrashvili was born in 1963, in Tbilisi. He got his MD status when he was 25 years old and completed his PhD at the age of 32 from a postdoctoral study in Tbilisi State Medical University. He is Associate Professor of Surgery, of Tbilisi State Medical University and Senior General Surgeon of Kipshidze Central University Hospital (Tbilisi, Georgia). He has published more than 80 scientific articles in international peer reviewed journals. He also is serving as an editorial board member and a reviewer of various international medical journals. He is member of several international surgical associates.
Abstract
BACKGROUND Damage control surgery (DCS) is one of the major advances in surgical techniques used in polytrauma patients in the past 25 years. The central principle of DCS is that patients are more likely to die from the “lethal triad†of hypothermia, coagulopathy and metabolic acidosis than from a failure to complete operative repairs. The goals of the DCS are to identify injuries, control haemorrhage, and control contamination. In patients with major abdominal trauma DCS avoids extensive procedures on unstable patients, stabilizes potentially fatal problems at initial operation, and applies staged surgery after successful initial resuscitation. In this retrospective study we evaluate the results of DCS in patients with severe injury to the abdominal organs. MATERIAL AND METHODS The evaluated group included 20 patients with severe abdominal trauma who underwent damage control laparotomy in the 2008-2014 years. There were 17 men and 3 women; the age range was 21 to 62 years. DCS was indicated in the patients with blunt abdominal trauma (13 patients) or penetrating trauma (7 patients). DCS included simple surgery (rapid abdominal exploration with haemorrhage and contamination control, temporary abdominal wall closure without tension), resuscitation in the intensive care unit (correction of hypothermia, acidosis and coagulopathy) and definitive surgery. RESULTS DCS was most frequently performed for liver injury (11 patients), which was associated with multiple injury to the other abdominal organs and retroperitoneum in nine patients. Repeat surgery was carried out within 24 to 72 hours. Perioperative mortality was 15% (3/20). The reasons of death were progressive traumatic haemorrhagic shock in one case and brain oedema after concussion in two cases. The perioperative complication rate was 40% (8/20). The Complications were: biliary leakage and fistula formation in 3 cases, anastomotic leakage and fistula formation in 2 cases, rebleeding in abdominal cavity in 2 cases and intraabdominal abscess formation in 1 case. CONCLUSIONS: DCS is an effective method in the treatment of severe trauma to the abdominal organs in critically injured patients. With an organized approach, DCS can lead to improved patient survival.
ING HOW MOO
Changi General Hospital Singapore
Title: Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete
Biography
Dr. Ing How Moo has completed his MBBS at the age of 24 from University of New South Wales Sydney Australia and postgraduate MRCS (Ireland) at the age of 26. He is currently an Orthopaedic Surgery resident with an interest in trauma surgery. He has published 5 papers in reputed journals and has been invited to present at 4 international orthopaedic conferences held in Europe & Asia. He is active in research and currently conducting few trials.
Abstract
Introduction: Compartment syndrome isolated to the anterior thigh is a rare complication of soccer injury. Previous reports in the English literature on sports trauma-related compartment syndrome of the thigh are vague in their description of the response of thigh musculature to blunt trauma, magnetic resonance imaging (MRI) findings of high-risk features of compartment syndrome, vascular injury in quadriceps trauma, and the role of vascular study in blunt thigh injury. Case Report: We present herein the rare case of a 30-year-old man who developed thigh compartment syndrome 8 days after soccer injury due to severe edema of vastus intermedius and large thigh hematoma secondary to rupture of the profunda femoris vein. MRI revealed "blow-out" rupture of the vastus lateralis. Decompressive fasciotomy and vein repair performed with subsequent split-skin grafting of the wound defect resulted in a good functional outcome at 2-years follow-up. Conclusion: A high index of suspicion for compartment syndrome is needed in all severe quadriceps contusion. Vascular injury can cause thigh compartment syndrome in sports trauma. MRI findings of deep thigh muscle swelling and "blow-out" tear of the vastus lateralis are strongly suggestive of severe quadriceps injury, and may be a harbinger of delayed thigh compartment syndrome.
