Index

A Acute lung (ALI), 59, 183 AAST grade 3–5 injury, 133 Acute respiratory distress syndrome, 61, 183, Abbreviated injury scale, 14, 16, 53, 161 231, 338 Abbreviated laparotomy, 4–5, 9, 102 Adult respiratory distress syndrome, 56 Abdominal closure Advanced Trauma Life Support (ATLS ®), primary and delayed primary closures, 279, 300, 332 213–218 AIS. See Abbreviated injury scale retained foreign bodies, 218 AIS/ISS taxonomy, 14 Abdominal , 10, 47, Alanine aminotranferase (ALT), 343, 347 195, 199, 405–407 Alloderm®, 225 Abdominal decompression, 406–407 American Association for the Surgery of Abdominal defects, not closed, 7 Trauma (AAST), 349 Abdominal dressing system, 215–216 American Pediatric Surgical Association Abdominal-inguinal incision, 144 (APSA), 345 Abdominal packing, 4, 183 American Society of Anesthesiologists, 232 Abdominal vasculature Amputation, 72 distinct zones, 138 Analgesia, 179–180 hemorrhage in pelvic area, 143–144 Anastomosis, 428–429 hemorrhage in upper lateral/peri-renal bowel, 136 area, 143 for colonic , 6 inframesocolic injury, 141–142 delayed, 133 porta hepatis, 145 end-to-end, 143 supramesocolic injury, 138–141 evidence for primary, 428 injury associated, blunt abdominal gastrointestinal, 129 trauma, 137 small bowel and colon, 212 Abdominal wall defects, management, 240 Anatomical resections, hepatic trauma, 130 definitive reconstruction, 243–244 Angiography, 269, 271–274, 306, 362 modified components, separation Antibiotic bead pouch, 78 technique, 244 Antibiotic nailing, 77–78 operative approach, 245–246 Aorta repairing methods, 342 planned ventral hernia, 242 Aortic cross clamping, 268 wound, temporary coverage of, 241–242 Aortic injury, treatment, 268 Accordion method, treatment, 393 Aortic occluder, 316 Acidosis, 6, 34, 48, 55, 84, 85, 88, 125, 176, Aortography, 341 358. See also Metabolic acidosis ARDS. See Acute respiratory distress ACS. See Abdominal compartment syndrome syndrome ACTH-stimulation tests, 193 Arterial bleeding, pelvic fractures, 300 Active hemorrhage, 126 Arteriovenous loop, 255

453 454 Index

Aspartate aminotransferase (AST), 343, 347 Cattel-Braasch maneuver, 325 Associated injuries, 9 CD11b/CD18 expression, 47 Atlas fractures, 292–293 Cellular immune response, 31 Atriocaval shunt, 131 lymphocytes, 33 monocytes, 33–34 PMN-endothelial interaction, 31–32 B ICAM-1, 32 Bacterial load, 79 L-selectin, 32 Bag-Valve-Mask (BVM) ventilation, 105 polymorphonuclear granulocytes, 31 Balloon tamponade liver, 129 Central nervous system (CNS), 54, 268 Base deficit (BD), 45 inflammation, 59 Battalion aid station (BAS), 370 Central venous pressure (CVP), 85 Bedside laparotomy (BL), 427 Cerebral perfusion pressure (CPP), 58 Beta-blockade, 268 Cerebrospinal fluid (CSF), 59 Bilateral hypogastric artery embolization, 274 Cervical spine clearance protocol, 292 Biologic meshes, 408 Cervical spine immobilization, 292, 335 Bispectral index (BIS), 180 Chance fractures, 293–294, 343, 350 Chess game, reconstruction, 251–253 limb injury, 389 Chest primary blast effect, 388 injury, 61–62 secondary blast effects, 389 wall closure, 148 tertiary blast injury, 389 x-ray findings, 88 tympanic membrane injury, 388 Child abuse, 350 Blood-borne immunocompetent cells, 59 Chimeric flap, 255 Blood brain barrier (BBB), 56, 58 Chimney effect, 301 Blood pressure, 17, 84, 106, 109, 112, 190, Civilian terror attacks, damage control 232, 268, 333 approach, 387 Blunt , 54, 61 benefits and risks, 398–399 patients, 84 blast injury, 388–389 Bowel anastomosis, 136. See also DCO surgery, terror attacks, 395–398 Anastomosis diagnostics and management, 393–394 Bowel discontinuity, 198 emergency department level, 391–393 B-type natriuretic peptide (BNP), 186 surgeon-in-charge, role of, 393–394 patients, 45 later control, 394–395 Burn , 49 pre-hospital level, 390 Burst fractures, 293 evacuation, 391 BVM ventilation, 105 strategies and recommendations, 389–390 Clamping, bleeding control, 318 Coagulation system, 28 C coagulopathy, 34, 60–61, 86–87, 92, 176, Calcium associated cytotoxicity, 58 301, 349, 397, 426 Canadian C-Spine Rule (CCR), 292 and complement systems, interaction, 34 Capillary-leak syndrome, 56 Coagulopathy. See Coagulation system Cardiac Coil embolization, 267, 268 contusions, 340–341 Colonic injury, 136–137 dysfunction, 60 Combined pancreatoduodenal injury, 135 tamponade, 341 Combitube®, 104, 109 Cardiopulmonary bypass (CPB), 178 Common lower extremity injury, 70 Cardiovascular management Commotio cordis, 341 hemodynamic support, 185 Complex lacerations, duodenum, 134 monitoring, status and resuscitation Component separation end-points, 185–186 and reconstruction of abdominal wall, 8 vasopressor support, 186–187 stages of, 224 Carotid injury, 284 technique, 408 Index 455

Compression fractures, 293 operative care, 6 Compression splints, 304 osteosynthesis, 71, 157 Concussions, 334 reconstructions, 412 Controlled resuscitation, 49 stabilization following DCO, 166–168 Correction, lethal triad, 198 therapy, 268 Counter-regulatory anti-inflammatory treatment area, 326 response (CARS), 358 Devastating injury, gastroesophageal junction, Craniectomy, 281–282 133 Critical care team, 199 Diagnostic angiography, 265, 266, 273 CT scan, 4, 105, 109, 115, 266, 269, 271, 273, Diagnostic peritoneal lavage (DPL), 344 282, 293, 302, 333, 334, 336, 341, 345 DIC. See Disseminated intravascular Cytokine system coagulation granulocyte-monocyte colony-stimulating- Diffuse axonal injury (DAI), 334–335 factor, 30–31 Direct venorrhaphy, 325 interleukin-1, 29–30 Disseminated intravascular coagulation, 61, interleukin-6, 30 87, 176, 194 interleukin-10, 31 Distraction osteogenesis, 255 TNF-a and receptors, 29 Double balloon tamponade, 319 Duodenal injuries in children, 350 Duodenum, 133–134 D Dynamic skin suture, 253 Damage control, 265, 381–382 combined sternotomy and laparotomy, 10 concept of, 357 E indications, 8 Early total care, 157, 164, 165, 250 abdominal compartment syndrome, 10 Eastern Association of the Surgery of Trauma associated injuries, 9 (EAST), 368 early decision making, 8 Elderly trauma patient, orthopedic damage planned reoperation, 10 control, 358 triad of death, 9 benefits and risks and interventional radiology (see avoiding infection, 361 Interventional radiologic controlling hemorrhage, 361–364 techniques) pain control, 361 laparotomy, 123–125 limb salvage, 359–360 operation, 8 strategies and recommendations, 358–360 phase III techniques, 211–212 timing of converting external fixator, phase III, timing of, 210 360–361 phase IV (see Soft tissue defects, Elective general surgeons, 4 reconstruction) Emergency department (ED) resuscitation, principles, 10–11 102 Damage control orthopedics (DCO), 155, 164, airway, 108–109 165, 250, 256, 358 breathing, 109–110 (DCS), 405, 406, 425 circulation, 110–113 Decision-making factors, 35–36, 48 disability, 113–114 clinical parameters, as aids for, 232–233 Emergency flap, 256 Decubitus ulceration, 291 Emergency medical system (EMS), 101 Definitive Endocrine management, 192–193 abdominal closures, types, 432 Endoscopic retrograde abdominal wall reconstruction, 220–224 cholangiopancreatography (ERCP), care area, 316 135, 351 care facility, 377 Endotoxin, 30 fascial closure with, 195 Endovascular stenting (EVS), 268 fracture fixation, 35 bridging procedure, 321–322 fracture stabilization, 161 Enteric fistulae, 219 456 Index

Entero-atmospheric fistula (EAF), 220, Fracture treatment and immunologic 407–409 markers, 236 Epidural hematomas, children, 335 Free flap surgery, 254–255 Esophageal injury, 147 Fuller zones, superior mesenteric artery, 140 ETC. See Early total care European trauma registry, 16 Euthanasia, 376 G Exacerbating systemic inflammation, 27 Gastric resection, 133 Expanded polytetrafluoroethylene (ePTFE), Gastrocnemius flap, 260. See also Flaps 222, 223 Gastrointestinal anastomosis (GIA) stapler, 129 External fixation-stabilization, pelvis, 304 Gastrointestinal management, 187 Extracellular matrix (ECM), 223 bowel discontinuity, 189 Extrahepatic biliary injury, 131–132 enteral access, 188–189 Extraluminal balloon tamponade, 316 feeding, 187–188 Extraperitoneal pelvic packing, 274 stress-ulcer prophylaxis, 187 Extremity compartment syndrome (ECS), Gastrointestinal repairs, 212–213 414–415 General care, patient concomitant injury management, 197 diagnostic studies, 197–198 F oral hygiene, 196 Fascial dehiscence (FD), 411–412 skin care, 197 Fasciotomy, 142, 326–327, 415 venous thromboembolism prophylaxis, 197 Femoral diaphyseal fractures, 73–74 Geriatric patients, 114–115 Femoral nailing, 156–158, 231 German Society of (DGU), 53 Femur shaft fracture, algorithm for German Trauma Registry, 161 fixation, 93 Glasow coma scale (GCS), 90, 333 Fibrin sealant dressing, 318–319 Glisson’s capsule, 128 Fibula fractures, 72 Global burden of injury, 13–14 Fistula VAC Grade III open tibial fractures, 72 in situ, 221 Gram-negative bacteria, 79 technique, 409 Granulocyte-monocyte colony-stimulating- Fixateur extern, 250 factor (GM-CSF), 30–31 Fixation principles Guillotine amputation, 319 conversion of external fixateur, 235 Gun-shot wounds (GSW), 16 orthopedic injuries, 234 patients, 337–338 Flaps H coverage, 75 Halo vest, 292, 293 distant flaps, 254 Hannover Rehab Study, 444–446 free flap, 251, 254–255 functional long-term outcomes, 447–448 local flap, 251, 254 outcome measures, 447 Floating stoma, 408 study population, 446–447 Fluid, and electrolyte management Hannover score for outcome electrolytes, 190 (HASPOC), 442, 447 fluid choices, 189–190 , management, 279–280 volume of administration, 190 cranial facial injury Focused abdominal sonogram in trauma pneumocephalus/ CSF leak, 284 (FAST), 302, 344 skull base fractures, 284 Fogarty balloon, 321 ICU care in OR, 285 Forward resuscitative surgery (FRS), 372–374 initial assessment, 280–283

Fractional inspired oxygen (FiO2 ), 184 aggressive neurocritical care, 282 Fracture-dislocations, thoracolumbar basic questions to be addressed, 280 spine, 294 decision-making flow sheet, 281 Index 457

intracranial pressure, treatment of, Hypovolemia, 54, 179, 191, 267, 301, 332, 281–282 347, 379 operative plan, 280–281 Hypoxemia, 58, 104, 109, 176, 280, 338 primary CNS injury, treatment of, 282–283 “talk and die” syndrome, 280, 282 I orthopedic injury, 285 ICU hand-off report, 175 spine injury, 284–285 Immune response decompression/stabilization, 284 initial systemic, 26–27 vertebral artery injury, 285 local, 26 thoracoabdominal injury, 283 Immunological changes, after trauma, 157–162 bilateral “blown” pupils, 283 Immunologic alterations, 61 craniotomy, 283 Infection, DCO surgery, 416–417 early cranial imaging, 283 Infectious Heart rate, 83 complications, 80 Helical CTs, cervical spine disease management, 193 injuries, 292 Inflammation with MODS, 27 Hematoma, 78, 123, 130, 141, 143, 168, 254, Inflammatory response, 56–58 303, 335, 350, 406 of male patient, 160 Hematothorax, 61 Inframesocolic injury, 141–142 HemCon®, 113 Injuries Hemicraniectomy, 282 global burden, 13–14 Hemipelvectomy, 309 heart, 148 Hemodynamic involving instability, 132 genitourinary tract, 145 stability, 198 lung parenchyma, 147 Hemorrhage, 4, 143 patterns, by age group, 19, 20 Hemorrhagic shock, 84–86 reperfusion, 27 Hemostasis, kidney, 270–271 significant, define, 16 , 339–340 tissue devascularization, 133 Hepatic artery ligation, 130 (ISS), 14, 16–18 Hepatic injury, 5, 269 Inspiratory:expiratory time (I:E), 184, 185 Hepatic parenchymal resections, 125 Intensive care unit (ICU), 53 Hepatic traumatic injuries, 130–131 injury description, 16 Hepatic vein, 130 continued resuscitation, 147 HLA-DR phase, damage control, 173 expression, immunoparalysis, 31 staff, 173 measurements, 35 Intercellular adhesion molecule-1 (ICAM-1), suppression, 56 29, 32, 58 Host defense response, 54 Interleukin-1, 29–30 Human acellular dermal matrix (Alloderm®), Interleukin-6 and 10, 28, 30 408, 433 International normalized ratio (INR), 176 Humoral immune response Interventional radiologic techniques, 265–267 complement system, 28–29 blunt pelvic fracture bleeding, 271–274 cytokine system, 29–31 extremity injuries, 267 Hypercapnia, 55, 185 guide decision making, 266 Hypertonic saline (HTS), 107, 108, 110 intraabdominal injuries, 268–271 Hypotension, 106, 180 thoracic injury, 268 in transport, 8 Interventional radiology (IR), 199 Hypothalamic-pituitary-adrenal Intestinal axis, 55 contamination, 4 Hypothermia, 84, 85, 87, 93, 160, 177–178, injury, 133 347, 378, 426, 429 Intra-abdominal abscess (IAA), 409–410 458 Index

Intra-abdominal hypertension (IAH), 183 as target organ, 57 Intra-abdominal pressure (IAP) trauma, consequences, 63 monitoring, 49 Lymphocytes, 33 Intracranial pressure (ICP), 58 Intraluminal balloon occlusion, 316 Intramedullary nails (IMN), 416 M Intramedullary unreamed nail, 250 Magnetic resonance cholangiopancreatography Intramural hematoma, 133 (MRCP), 135, 350 Intraoperative coagulopathy, 4 Magnetic resonance imaging (MRI), 73, 292, Intra-vascular shunts, 202 334, 336 Ischemia, 27–28 Major extremity fractures, fixation, 156 Ischemia/reperfusion (I/R) injury, 28 outcome study (MTOS), 17 Management and monitoring, during J transport, 198 Jet lavage, 250 Mangled extremity, 74–76 Mass casualty events, 367. See also Civilian terror attacks, damage control K approach; Military environment, Kauder tampon, 128 management of mass casuality KCI V.A.C.®, 215–217 civilian and military trauma system Kelly clamps, 130 components, 369 Ketamine, 201 damage control surgery, 381–382 Kocher maneuver, 134, 325, 326 military field medicine, 368 trauma centers, 367–368 Mass casualty incidents (MCIs), 369 L Massive injury, hepatic parenchyma, 125 Lactate levels, 86 Maxillofacial hemorrhage, 319 Laparoscopic splenectomy, 346 Mesenteric Laparotomy, 239–240 artery, 323–324 Laryngeal mask airway (LMA), 104 bleeding and avulsion, 133 Lateral venorrhaphy, 131 defects, 136 Length of stay (LOS), 53 disruptions, 350 Limb damage control (LDC), 69 hematomas, 136 adjunctive measures, 76–80 ischemia, 388 fracture type, 71 Metabolic acidosis, 176–177 diaphyseal tibia/fibula fractures, 72 Metabolic failure, 132 femoral diaphyseal fractures, 73–74 Military antishock trousers (MAST), 303 pilon fractures, 71–72 Military environment, management of mass tibial plateau fractures, 72–73 casuality mangled extremity, 74–76 damage control, 381–382 Liver, 125, 347 forward surgical teams (FSTs), goal, balloon tamponade, 129 372–373, 375 injury, 123, 316, 343 levels of care, 370 packing, 126 Level I, 370 Lower Extremity Assessment Project (LEAP), Level II, 370 69, 444–445 Level III, 371 L-selectin, 32 Level IV, 371 Lung Level V, 371 accumulation of neutrophils, 29 , 371–372 contusions, 61, 88 in far forward environment, 375–376 function, 233 FRS role, triage decision, 372–374 injuries, 397 perioperative, and intraoperative triage, parenchyma, 147 377–378 Index 459

physiologic, anatomic, and historic definitive abdominal closure types perspectives, 378–381 biosynthetic meshes, 433 practical considerations, component separation (CS), 432 and priorities, 375 polyglycolic acid mesh, 433 practical utility, 376–377 polypropylene mesh, 432–433 triage officer, 374–375 polytetrafluoroethylene (PTFE) Missed injuries, 199–200. See also Injuries mesh, 433 MODS. See Multiple organ dysfunction fistulas in open abdomen, 434 syndrome long-term outcome, 435 MOF. See Multiple organ failure ostomy in open abdomen, 434 Monocytes, 29, 33–34 planned reexploration, 427–428 Mortality post-operative judgment, DCS, 425 with male gender, 17 primary closure failure, 432 rates for pancreatoduodenal injuries, 133 time for reconstruction, 428–429 rates in patients, two organ failures, 413 timing of fascial closure, 429–431 in trauma patients, 357–359 unplanned reexploration, 426–427 Motor vehicle accident (MVA), 53 Open hindfoot injuries, 75 Multi-compartment injuries, 9 Opioids, 180 Multiple organ dysfunction syndrome, 26, Optimal nutritional condition, 8 358, 412–414 Organ-failure-related death, 157 Multiple organ failure, 156, 167, 231 Orthopedic Multisystem injuries, 49 fixation of pelvis, 307 injuries, 53, 202, 317, 361, 391, 397 interventions, 442 N management, and complications, Naso-gastric decompression, 196 193–194 Nasotracheal intubation, 104 splints and casts, 197 National emergency X-radiography utilization surgeons, 88, 256 study (NEXUS), 292, 336 Osmotic diuretics, 282 National trauma databank (NTDB), 331 Osteoporosis, 16 NATO emergency war surgery manual, 375 Osteosynthesis, 75, 162 Natural killer (NK) cells, 59 Overwhelming post-splenectomy sepsis Necrosis, 27, 88 (OPSI), 346 Needle cricothyroidotomy, 105 Oxygenation capacity, 89

Nerve growth factor (NGF), 59 Oxygenation saturation (SaO2), 184 Neuroendocrine axis, 55 reaction, 54–56 P Neurogenic pulmonary edema (NPE), 59, 60 Packed red blood cell (PRBC), 45 Neuroinflammation, 58–59 Pancreas, 134–135 Neurological management, 179 Pancreatectomy, 134 analgesia, 179–180 Pancreatic injury, 134 NMBA in paralysis, 182–183 Paralysis, 182–183 sedation, 180–182 Partial thromboplastin time (PTT), 86 Neuromuscular blockading agents (NMBA), 182 Particulate/gel foam embolization, 274 New injury severity score (NISS), 161 Patient’s condition, determination, 89 Non-steroidal anti-inflammatory agents, 112 borderline condition, 89–90 Nonsurgical bleeding, 136 in extremis, 90 stable condition, 89 unstable condition, 90 O Peak airway pressure (PAP), 48, Older patients, vulnerability, 19 406, 431 Open abdomen, management Peak inspiratory pressure (PIP), 184 abdominal wall reconstruction, 431 Pediatric intubation, 337 460 Index

Pediatric trauma CT scan, 302 children vs. adults FAST, use of, 302 anatomic differences, 331–332 pelvic radiographs, 301–302 physiological differences, 332 PXR, use of, 302 psychological differences, 332 subgroups of patients, 299–300 initial assessment, 332–333 Pelvic packing (PP), 306–307 injury-related death, data, 331 Pelvic X-ray (PXR), 302 secondary survey and management Percutaneous pelvic fixation, 305 , 343–344 Perforator flap, 255 bony injuries of chest, 337–338 Perineal wounds, 308 cardiac injuries, 340–341 Perioperative hemoglobin, 112 cervical spine injuries, 335–336 Persistent bleeding/coagulopathy, 199 diaphragm injury, 342 Phenytoin, 334 diffuse brain injury, 334–335 Physiologic pattern, trauma patients, 4 focal head injuries, 335 PiCCO catheter, 186 fractures, 334 PI3-kinase, 29 gastrointestinal injuries, 349–351 Pilon fracture management, 71–72 great vessel injuries, 341–342 Pinch test, 222 hemothorax, 339–340 Pin placement, 70 kidney, 348–349 Pin-track infections (PTI), 416 liver, 347–349 Planned ventral hernias, 218–219 neurologic trauma, 333–334 fistula management, 219–220 , 338–339 Plasma concentrates, IL-6 and IL-8, 159 , 338 Plastic surgery, 75 spleen, 344–346 Platelet transfusion, 112 thoracic trauma, 336–337 Plates, 250 tracheobronchial injuries, 340 PMN-endothelial interaction, 31–32 Pelvic compression belt, 303–304 Pneumococcal vaccine, 346 Pelvic external fixator, 362 Pneumothorax, 61

Pelvic fractures, 299–300 pO2 /FiO2 ratio, 159, 166 bleeding treatment, 271–274 Polymorphonuclear granulocytes (PMN), 27, 31 damage control orthopedics, 307–308 Polymorphonuclear leukocytes (PMNs), 58 fixation of major extremity, 92 Polytetrafluoroethylene (PTFE) patch hemipelvectomy, 309 aortoplasty, 139, 140 hemodynamically unstable patients, 303 Polytrauma demography, 18 hemorrhage control, 300–301 Polytrauma mortality, 19–20. See also Mortality invasive treatment measures, 304–307 Polytrauma patients, 299 acute fracture fixation, 305 early clinical outcomes, 442–444 angiography and embolization, 306 functional long-term outcomes, 444 arterial inflow arrest, 305 Hannover Rehab Study, 445–448 external fixation, 304 Lower Extremity Assessment Project pelvic C-clamp, 304–305 (LEAP study), 444–445 pelvic packing, 306–307 functional outcomes, 440 mortality, 299 activity and participation, 440–441 noninvasive treatment measures, 303–304 HASPOC scoring systems, 442 ongoing treatment impairment of body function, 442 complex fractures, 308–309 patient satisfaction and QOL definitive stabilization, closed measures, 441 fractures, 308 head injuries in (see Head injury, open fractures, 308 management) wounds treatment, 308 outcome research, 439–440 radiographic assessment, and fracture pelvic fractures(see Pelvic fractures) classification, 301–302 scoring systems, 90–93 classification system, 302 spine injury (see Spinal injuries, treatment) Index 461

Porta hepatis, 145 (RTS), 84 Portal Richmond agitation-sedation scale (RASS), triad injury, 131–132 180, 181 vein, 326 Right ventricular end-diastolic volume index venous injury, 270 (RVEDVI), 186 Positive end-expiratory pressures (PEEP), 184 Riker sedation–agitation scale, 180 Post injury secondary ACS, 49 Road traffic crashes, 16 Post injury systemic inflammation, 57 Rummel tourniquet, 127 Posttraumatic sepsis, 29 Pregnant patients, 115–116 Pre-hospital resuscitation, 102 S airway and breathing, 103–106 Seatbelt contusions, 350 circulation, 106–108 Secondary brain damage, 58 rural vs. urban environment, 102–103 Secondary orthopedic stabilization, 230 Prewitt balloon, 323 biochemical markers, 230–232 Primary wound closure, 253 clinical parameters, 232–233 Pringle maneuver, 127 fixation principles, 234 Procedural sedation, 200–201 possible markers for determination, 233 Proinflammatory cytokines, 36 secondary surgery, clinical studies of, 230 Prolonged operative procedures, 3 surgical principles, 235 Prothrombin complex (PCC), 112, 113 Secondary wound closure, 253 Proximal coil embolization, 271 Sedative agents, 181 Proximal hypogastric coil embolization, 274 Sepsis, 26–33, 137, 409, 413 Pseudocyst formation, 351 Serum bicarbonate, 83 Pulmonary Shunts, 316–317 contusion, 338 Sickness impact profile, 445 , 157 Significant thoracic trauma, 19 hydrostatic pressure, 60 SIRS. See Systemic inflammatory response management, 183 syndrome oxygenation, 184–185 Skin graft ventilator strategies, 184 full-thickness, 254 Pyloric exclusion, 3, 134 separation assessment, 222 split-thickness, 254 Skull base fractures, 284 Q Small bowel, 135–136 Quality of life (QOL), 440, 441 Soft tissue defects, reconstruction QuikClot®, 113 closure of soft tissue, 250–251 acute bone-shortening/bone transport, 255 R chess game of reconstruction, 251–252 Radical oxygen species (ROS), 27 flaps, application, 254–255 Ramsay scale, 180 techniques, 253–254 Recombinant GM-CSF, 31 vacuum-assisted closure, 255 Rectal injuries, 137 fracture stabilization, 250 Refractory acidosis, 199 interdisciplinarity, importance, 258 Renal management, 191–192 lower limb region, 259 Reperfusion, 27–28 calf, 260–261 Reperfusion syndrome, 48 foot, 261 Respiratory dysfunction, 59–60 knee, 260 Resuscitative thoracotomy (RT), 113 thigh, 259 Reticuloendothelial system, 28 radical debridement, 250 Retrohepatic vena caval injury, 130–131 timing of treatment, and closure, 256 Retroperitoneal bleeding, 133 classification, on time categories, Retroperitoneum, 300 256–257 462 Index

Soft tissue defects, reconstruction (cont.) Tegner activity score, 441 upper limb region, 258 Temporary abdominal closure, 145–146 back of hand, 259 Temporary abdominal dressing, 146 elbow/forearm, 259 Temporary skeletal fixation, 198 upper arm, 258 Tenants, damage control Soft tissue injuries, 87–89 definitive abdominal closure, 6–8 (SCI), 114 hemorrhage and contamination, rapid Spinal cord injury without radiological control, 5 abnormality (SCIWORA), 336, 338 operative repairs, return for completion, 6 Spinal injuries, treatment, 295 rapid transport to definitive care, 5 imaging, and cervical spine clearance, 292 resuscitation, 6 injury types, management, 292–294 Terrorism, and disaster management, 368 atlanto-occipital articulation injury, 292 Terror-related injury (TRI), 388 atlas fractures, 292–293 Tertiary examination, 199–200 Hangman’s fractures, 293 Thoracic damage control, 201 odontoid fractures, 293 Thoracic injury, 146–147 subaxial fractures, 293 Thoracic trauma score (TTS), 88 subluxations, and dislocations, 293 Thoracic vasculature, 147 thoracolumbar fractures, 293–294 Thoracostomy, 339 optimal timing, surgical intervention, Thromboplastin, 60 294–295 Thromboxane, 30 prevalence rate, 291 Tibial plateau fractures, 72–73 transport, and clinical evaluation, 291–292 Total hepatic occlusion, 132 Spleen, 132–133 Tourniquet, 250, 315–316 Spleen sparing distal pancreatectomy, 351 Tractotomy, 147 Spleen-sparing pancreatectomy, 134 Transcatheter embolization, 265, 268 Splenectomy, 133, 134, 271, 346 Trans-esophageal echocardiography Split-Thickness Skin Graft (STSG), 433 (TEE), 186 Standardized death rates (SDR), 15 Transforming growth factor-b (TGF-b), 59 Stent grafts, 267 Transport, DC patients, 199 Stents, 317 Trauma Audit and Research Network Stomach, 133 (TARN), 17 Stryker® kit, 414–415 Trauma registry, 18 Subdural hematomas, children, 335 (TBI), 53, 60, 104, 107, Suicide bombers, 389 114, 333–334 Superior mesenteric artery (SMA), 130 Traumatic injury, GI tract, 133 Superoxide production, 231 Trauma, gallbladder, 131 Supramesocolic injury, 138–141 Triad of death, 9 Surgery, involving debridement, 75 Tris-hydroxymethyl-amino-methane Surgical bleeding, 129 (THAM), 177 Swan–Ganz catheter, 85 Tumor necrosis factor-a (TNF-a), 59, 61, 231. Systemic inflammatory response syndrome, See also Cytokine system 26, 157, 358 and receptors, 29–31 Systolic blood pressure (SBP), 83, 107

U T Unconsciousness, 109 Tactical abbreviated surgical control (TASC), 382 TARN database, 17, 18 V T-cells, 59 VAC, promising technique, 80 function, 58 Vacuum-assisted closure, 250, 251, 255, 408 T-cytotoxic suppressor cells, 59 Vacuum-assisted dressings, 7, 78 Index 463

Vacuum-assisted wound closure technique pulmonary vessels, 322 (VAWC), 195 thoracic vena cava, 322 VAC wound therapy, 79 Vascular repairs, 212 Vascular injuries, and damage control Venous thromboembolism (VTE) approach, 315 prophylaxis, 197 abdomen, 323 Ventriculostomy, 282, 284 abdominal aorta, 323–324 Vertebral artery, 320–321 celiac axis, 324 injuries, treatment, 285 groin, 326 Vulnerable groups, 14–16 iliac vessels, 325 inferior mesenteric artery, 324 inferior vena cava, 325 W portal vein, 326 Warfarin-induced coagulopathy, 111 renal vessels, 325 Warming techniques, 178 superior mesenteric artery and vein, Wittmann Patch™, 218 324 Wound and open-abdomen management definitive occlusion general wound care, 194–195 amputation, 319 intra-abdominal pressure management, coiling, 318 195–196 hemostatic agents and glues, 318–319 laceration repair, 194–195 ligation, 318 recurrent abdominal compartment extremity vessels, 326–327 syndrome, 196 flow restoration Wound complications, 410 complex repairs and grafts, 317 fascial dehiscence (FD), 410–411 lateral repair, 317 wound infection (WI), 410–411 shunts, 316–317 Wound data and munitions effectiveness team stents, 317 (WDMET), 379 maxillofacial hemorrhage, 319 Wound management objectives, 76 neck region, 319–320 carotid injuries, 320 cervical venous injuries, 320 Y subclavian vessels, 321 The Young and Burgess classification vertebral arteries, 320–321 system, 302 temporary occlusion, 315–316 thorax aorta, 321–322 Z azygos vein, 322–324 Zeolite hemostatic dressing, 318