A protocol for the management of adhesive small bowel obstruction.

Background: Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively.

Methods: Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours.

Nonoperative management of solid organ injury diminishes surgical resident operative experience: is it time for simulation training?

Background: Nonoperative management (NOM) of solid abdominal organ injury (SAOI) is increasing. Consequently, training programs are challenged to ensure essential operative trauma experience. We hypothesize that the increasing use and success of NOM for SAOI negatively impacts resident operative experience with these injuries and that curriculum-based simulation might be necessary to augment clinical experience.

Supporting the Global War on Terror: a tale of two campaigns featuring the 250th Forward Surgical Team (Airborne).

Background: Forward Surgical Teams (FSTs) are 20-person units designed to perform front-line, life-saving combat surgery. This study compares the employment, injuries encountered, and workload of an airborne FST in two widely varying campaigns.

Methods: The 250th FST provided far forward surgery for initial entry assaults and follow-on stability operations in Afghanistan (Operation Enduring Freedom [OEF]) and northern Iraq (Operation Iraqi Freedom [OIF]).

A three-year follow-up on standard versus thin wall ePTFE grafts for hemodialysis.

Purpose: Expanded polytetraflouroethylene (ePTFE) grafts are the most popular prosthetic grafts for hemodialysis patients in whom autogenous fistulas cannot be constructed. Long-term studies to study the durability and complication rate of the different wall configurations of ePTFE grafts have not been carried out. The primary, secondary, and cumulative patency and other complications between standard thickness (STD) and thin wall (THN) 6 mm stretch ePTFE grafts (WL Gore & Assoc, Flagstaff, AZ) was prospectively evaluated.

Changing patterns of arterial injuries associated with fractures and dislocations.

Background: Significant changes occurred over a 4.5-year period in the causes, diagnosis, and treatment of arterial injuries associated with skeletal fractures of the extremities.

Study Design: The trauma registry data of 1,091 consecutive patients with fractures, dislocations, or both, were reviewed for the diagnosis of associated arterial injury documented by arteriography or an exploratory operation.

Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma.

Background: Optimal management of patients with Zone II penetrating neck trauma for vascular injury remains controversial. Retrospective studies have demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. This study was undertaken to evaluate prospectively the safety and accuracy of physical examination in determining the management of patients with penetrating Zone II neck trauma.