Management of the Mangled Extremity
AbstractPurpose of ReviewThe management of the mangled extremity has undergone significant evolution over the past decades. Understanding these advancements and the importance of a multi-disciplinary approach to these injuries is critical to patient outcomes.Recent FindingsHistorically devastating extremity injuries were often subject to amputation. Developments in initial resuscitation and an integrated management of these patients has allowed for the potential of limb salvageability. Prior scoring systems to determine candidacy for salvage have fallen to the wayside with a lack of reliable outcome measures. The early rec...
Source: Current Surgery Reports - March 6, 2023 Category: Surgery Source Type: research
The Evolving Management of Leaks Following Sleeve Gastrectomy
AbstractPurpose of ReviewSleeve gastrectomy has become one of the most common bariatric surgical procedures world-wide. The complication rate overall is low, but staple line leak remains one of the most morbid and difficult to manage complications. The management of staple line leaks has evolved over time and now several non-operative, endoscopic, and surgical options exist with varying rates of success.Recent FindingsBased on the available data some interventions appear to be more efficacious than others, and modern management has moved towards a core set of practices. Endoscopic interventions may help many patients avoid...
Source: Current Surgery Reports - March 6, 2023 Category: Surgery Source Type: research
Management of the Normal and Difficult Pediatric Airway: Unique Challenges in the Time of COVID-19
AbstractPurpose of ReviewThis review focuses on the challenges faced by acute care healthcare workers in the management of the normal and difficult pediatric airway during the COVID-19 pandemic and how these protocols and practices evolved during the pandemic. The current state of knowledge on timing of surgery and anesthesia is also discussed.Recent FindingsIn the early days of the pandemic, information about the SARS-CoV-2 virus and disease process was scarce. Governmental, healthcare, and professional organizations created several guidelines to protect invaluable healthcare workers from the contagious virus while also d...
Source: Current Surgery Reports - March 4, 2023 Category: Surgery Source Type: research
Current Management of Hemodynamically Unstable Patients with Pelvic Fracture
AbstractPurpose of ReviewTrauma patients with a high-energy mechanism may sustain severe pelvic injury, leading to increased mortality from hemorrhage. Hemodynamic instability in the setting of pelvic injury should be rapidly addressed using the available resources.Recent FindingsInitial resuscitation utilizing ATLS teachings and necessary blood products is initiated while pelvic volume reduction can be achieved with a pelvic binder. REBOA may be employed to stabilize patients with pelvic bleeding, allowing for further intervention. Preperitoneal pelvic packing, external fixation, and angioembolization are techniques to ad...
Source: Current Surgery Reports - March 4, 2023 Category: Surgery Source Type: research
Emergency Department Thoracotomy in Trauma
AbstractPurpose of ReviewResuscitative thoracotomy performed in the Emergency Department is a potentially lifesaving maneuver in select trauma patients. Patient selection is based on guidelines set forth by the Eastern Association for the Surgery of Trauma (EAST) and the Western Trauma Association (WTA), and is predicated on likelihood of survival. This chapter will review technical aspects and trends of the use of resuscitative thoracotomy.Recent FindingsResuscitative thoracotomy is advocated for select patients who suffer from penetrating injuries; rarely blunt trauma victims may also benefit. The procedure consists of e...
Source: Current Surgery Reports - March 1, 2023 Category: Surgery Source Type: research
Blunt Cerebrovascular Injury
AbstractPurpose of ReviewBlunt cerebrovascular injury (BCVI) can result in significant morbidity and mortality. Early screening, type of medical therapy, timing of medical therapy and the utilization of endovascular interventions are important factors in the management of BCVI.Recent FindingsThe development of screening criteria in the trauma patient population has improved diagnostic yield, allowing for earlier treatment and better outcomes. While different screening criteria schemas have been published, recent literature suggests a universal screening protocol may be justified. Medical therapy using anticoagulation or an...
Source: Current Surgery Reports - February 28, 2023 Category: Surgery Source Type: research
Robotic Bariatric Surgery: An Update
This article will provide a review of the most recent literature regarding the use of robotics in bariatric surgery.Recent FindingsThe use of robotics in bariatric surgery, while still debated, is on the rise. The appeal of this platform includes improved surgeon ergonomics, visualization, dexterity as well as decreased dependence on surgical assistance for exposure and camera use. This must be balanced against learning curve, increased operative time and cost as well as safety profile. There are numerous retrospective studies that have been performed recently in an attempt to better define the utility of the robot in bari...
Source: Current Surgery Reports - February 27, 2023 Category: Surgery Source Type: research
The Case for Bariatric Surgery in Patients with Class 1 Obesity
AbstractPurpose of ReviewThis mini-review reports the current research and arguments for extending the inclusion criteria to offer bariatric surgery in the treatment of class 1 obesity (body-mass index of 30 –35 kg/m2) and obesity-related comorbidities.Recent FindingsRecent studies have described the benefit of bariatric surgery in the treatment and resolution of obesity-related comorbidities in patients with class 1 obesity, notably, type 2 diabetes.SummaryBariatric surgery cremains the single most effective intervention to effectively reduce excess weight and ameliorate metabolic comorbidities. Patients with class 1 o...
Source: Current Surgery Reports - February 27, 2023 Category: Surgery Source Type: research
Trauma Quality Improvement and Team Education: How Can We Better Optimize Our Training?
AbstractPurpose of ReviewThe relationship between high quality healthcare and its impact on healthcare expenditures has led to a push towards higher-quality care while using fewer resources. Trauma in particular stands out, as both clinical skills and non-technical skills are emphasized in an effort to achieve the best outcomes. Education focused on improving teamwork and team communication is at the forefront of improving quality in trauma care.Recent FindingsWithin the past 15 years, the Trauma Quality Improvement (TQI) Program has utilized risk adjusted benchmarks to provide each enrolled center with accurate comparis...
Source: Current Surgery Reports - February 21, 2023 Category: Surgery Source Type: research
Optimal Management of the Geriatric Trauma Patient
AbstractPurpose of ReviewAs our population continues to age, the proportion of geriatric patients continues to rapidly increase. As a result, age-specific recommendations in the setting of trauma have undergone considerable discussion. This review aims to identify strategies for optimal management of geriatric trauma patients. Specifically, it will focus on updated triage criteria and system-level enhancements to improve the management of geriatric trauma patients.Recent FindingsThe optimal care for geriatric trauma patients is centered around treating acute injuries while minimizing the impact of comorbidities. Recent res...
Source: Current Surgery Reports - February 20, 2023 Category: Surgery Source Type: research
Duodenal Injuries
AbstractPurpose of ReviewDuodenal injuries are rare but challenging injuries to manage for the acute care surgeon. These injuries often occur concomitantly with other organs and major vascular structures. Once diagnosed, these injuries have been managed in a variety of ways and historical beliefs are slowly being replaced by evidence when confronting some of these difficult injuries. This review reintroduces the important topic of duodenal trauma and attempts to discuss the mechanisms, diagnosis, outcomes, and most importantly, management of duodenal trauma.Recent FindingsManagement will be outlined along with organ injury...
Source: Current Surgery Reports - February 16, 2023 Category: Surgery Source Type: research
Management and Outcome of High-Grade Hepatic and Splenic Injuries
AbstractPurpose of ReviewHepatic and splenic injuries are commonly found in patients who experience trauma and result in significant morbidity and mortality. Historically, operative intervention was the first and only approach to high grade injury. Recently non-operative and endovascular interventions are increasingly utilized. However, exact indications for these approaches have yet to be fully characterized. This paper discusses the management options and outcomes of these high-grade hepatic and splenic injuries.Recent FindingsHigh-grade injuries include American Association for the Surgery of Trauma grade IV and V injur...
Source: Current Surgery Reports - February 16, 2023 Category: Surgery Source Type: research
Transfusion Management in Trauma: What is Current Best Practice?
AbstractPurpose of ReviewIn the past few years, transfusion strategies in trauma have changed dramatically. We aim to define current practices, explore the evidence leading to these shifts, and identify areas of contemporary research within this field.Recent FindingsSome major shifts include initiating blood products in the prehospital setting and favoring whole blood rather than individual blood components. Additional improvements include expanding trauma resuscitation to include AB plasma in untyped patients, several adjuncts given as part of massive transfusion protocols, and utilizing thromboelastography for individual...
Source: Current Surgery Reports - February 15, 2023 Category: Surgery Source Type: research
COVID, the Gut, and Nutritional Implications
AbstractPurpose of ReviewThe purpose of this review is to provide an overview of the current literature, recommendations, and practice guidelines on the nutritional management of and implications associated with COVID-19 infection.Recent FindingsParticular attention should be paid to the screening, prevention, and treatment of malnutrition in critically ill individuals with COVID-19 infection given the significant risk for complications and poor outcomes. Extrapolation of existing literature for the nutritional support in the critically ill patient has demonstrated early enteral nutrition is safe and well-tolerated in pati...
Source: Current Surgery Reports - February 11, 2023 Category: Surgery Source Type: research
Robotics in Plastic Surgery
AbstractPurpose of ReviewRobotic surgery represents a new frontier in minimally invasive reconstructive surgery. Minimally invasive surgery (MIS) and specifically robotic MIS can improve visualization, decrease morbidity, and allow for complex movements that cannot be achieved with standard operative approaches. The use of the surgical robot has expanded into multiple fields including general surgery, urology, thoracic surgery, gynecological surgery, and head and neck surgery.Recent FindingsOur institution has pioneered and expanded the use of the surgical robot across multiple arenas of plastic surgery. We have led the de...
Source: Current Surgery Reports - February 7, 2023 Category: Surgery Source Type: research
