The Utility of Advanced Lower-Extremity Duplex Using Pedal Acceleration Time in the Management of the Threatened Diabetic Foot.

Background: Patients with diabetes and diffuse infrageniculate arterial disease who present with chronic limb-threatening ischemia require an exact anatomical plan for revascularization. Advanced pedal duplex can be used to define possible routes for revascularization. In addition, pedal acceleration time (PAT) can predict the success or failure of both medical and surgical interventions.

Is there a role for REBOA? A system assessment.

Introduction: To analyze our experience to quantify potential need for resuscitative endovascular balloon occlusion of the aorta (REBOA).

Methods: Retrospective review of patients over a three-year period who presented as a trauma with hemorrhagic shock. Patients were divided into two groups: REBOA Candidate vs.

Pedal Acceleration Time (PAT): A Novel Predictor of Limb Salvage.

Background: In the setting of Peripheral Arterial Disease (PAD), pedal arch interrogation by ultrasound has not been well described. Patients with noncompressible vessels and/or open wounds of the foot may preclude the use of ankle-brachial indices, toe pressure measurements, or TcPO2, respectively. We propose that pedal artery interrogations with Pedal Acceleration Time (PAT) can be a predictor for limb salvage in patients with Chronic Limb-Threatening Ischemia (CLTI).

Plantar Acceleration Time: A Novel Technique to Evaluate Arterial Flow to the Foot.

Background: Arterial duplex ultrasound (DUS) and ankle-brachial indices (ABIs) are accepted methods for assessing lower limb arterial perfusion. However, in a significant number of diabetic patients, medial wall calcification often precludes an ABI measurement. Direct, noninvasive duplex imaging of the pedal arch in the setting of peripheral arterial disease (PAD) has not been well evaluated.

Traumatic thoracic rib cage hernias: Operative management and proposal for a new anatomic-based grading system.

Background: Traumatic Rib Cage Hernias (TRCH) requiring operative repair are rare and there is currently no literature to guiding surgical management.

Methods: Perioperative review of TRCH over 32 years. Five operative grades were developed based on extent of tissue/bone damage, size, and location.

Hematomas in Tiger Territory: An Endovascular Alternative to Wading In.

A 26-year-old man presented with gunshot wound to the epigastrium. At surgery, he was hemodynamically stable and had a tense hematoma with thrill in zone 2 (right side) and porta triad. After liver injury was controlled, he underwent percutaneous stenting of a renal artery-vena cava fistula and the hepatic artery injury was followed.

The evolution of care improves outcome in blunt thoracic aortic injury: A Western Trauma Association multicenter study.

Background: The management of blunt thoracic aortic injury (BTAI) has evolved radically in the last decade with changes in the processes of care and the introduction of thoracic endovascular aortic repair (TEVAR). These changes have wrought improved outcome, but the direct effect of TEVAR on outcome remains in question as previous studies have lacked vigorous risk adjustment and long-term follow-up. To address these knowledge gaps, we compared the outcomes of TEVAR, open surgical repair, and nonoperative management for BTAI.

Predictors of Outcome in Modern Surgery for Lung Abscess.

 Surgery for lung abscess is a challenging task. Timing and indications for surgery are not well established. Identification of predictors of outcome could help to clarify the role of surgery.

Western Trauma Association Critical Decisions in Trauma: Management of rib fractures.

This is a recommended management algorithm from the Western Trauma Association addressing the management of adult patients with rib fractures. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithm and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers.

Evaluation of Cervical Spine Clearance by Computed Tomographic Scan Alone in Intoxicated Patients With Blunt Trauma.

Importance: Current trauma guidelines dictate that the cervical spine should not be cleared in intoxicated patients, resulting in prolonged immobilization or additional imaging. Modern computed tomography (CT) technology may obviate this and allow for immediate clearance.

Objective: To analyze cervical spine clearance practices and the utility of CT scans of the cervical spine in intoxicated patients with blunt trauma.

Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries.

This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers.

Model for Team Training Using the Advanced Trauma Operative Management Course: Pilot Study Analysis.

Background: Education and training of surgeons has traditionally focused on the development of individual knowledge, technical skills, and decision making. Team training with the surgeon's operating room staff has not been prioritized in existing educational paradigms, particularly in trauma surgery. We aimed to determine whether a pilot curriculum for surgical technicians and nurses, based on the American College of Surgeons' Advanced Trauma Operative Management (ATOM) course, would improve staff knowledge if conducted in a team-training environment.

Use of negative pressure wound therapy with automated, volumetric instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness.

Objective: A growing body of literature supports use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) with positive clinical outcomes and potential cost savings. A retrospective analysis was performed to compare clinical outcomes of wounds treated with NPWTi-d versus NPWT and to estimate cost-differences between treatments based on clinical outcomes.

Methods: Data were extracted from records of patients with extremity or trunk wounds treated with NPWT (n = 34) or NPWTi-d using saline or polyhexanide (n = 48).