Fournier's gangrene reconstruction: A 10-year retrospective analysis of practice at Guys and St Thomas's NHS Foundation Trust.

Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management.

The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa.

Background: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma.

Methods: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa.

FDP avulsion: A washer technique.

Background: Flexor digitorum profundus (FDP) avulsion injuries occur following forced hyperextension of the distal interphalangeal joint (DIPJ).

Methods: We highlight a case report of FDP avulsion injury fixed using a single hole of a plate in combination with a cortical screw to act as a washer. A search and discussion of the literature is included.

Recurrent pneumothorax following chest tube removal in thoracic stab wounds: a comparative study between end inspiratory versus end expiratory removal techniques at a major trauma centre in South Africa.

Background: Tube thoracostomy (TT) insertion is a commonly performed procedure in trauma that is standardised, but the optimal removal technique based on the timing in relation to the respiratory cycle remains controversial.

Methods: A prospective study was undertaken at a major trauma centre in South Africa over a 4-year period from January 2010 to December 2013, and included all patients with pneumothorax secondary to thoracic stab wounds. TTs were removed by either end of inspiration technique (EIT) or end of expiration (EET) technique and the rate of recurrent pneumothorax (RPTX) following removal was compared.

Hanging-related injury in Pietermaritzburg, South Africa.

Background: Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor.Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described.

Objectives: To review experience with management of victims of hanging at a major trauma centre in South Africa.

Selective Nonoperative Management of Abdominal Stab Wounds with Isolated Omental Evisceration is Safe: A South African Experience.

Background And Aims: Selective nonoperative management of abdominal stab wound is well established, but its application in the setting of isolated omental evisceration remains controversial. The aim of the study is to establish the role of selective nonoperative management in the setting of isolated omental evisceration.

Materials And Methods: A retrospective study was conducted over an 8-year period from January 2010 to December 2017 at a major trauma center in South Africa to determine the outcome of selective nonoperative management.

Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience.

Introduction: Discrepancy in outcomes between urban and rural trauma patients is well known. We reviewed our institutional experience with the management of gunshot wounds (GSWs) in the specific setting of car hijacking and focused on clinical outcome between rural and urban patients.

Methods: A retrospective review was conducted at a major trauma centre in South Africa over an 8-year period for all patients who presented with any form of GSWs in car hijacking settings.

The spectrum of animal related injuries managed at a major trauma centre in South Africa.

Background: Humans come into contact and interact with an array of animals in a number of areas and environments. We set out to review our experience with animal-related injuries in Pietermaritzburg, KwaZulu-Natal, South Africa.

Method: All patients who sustained an injury secondary to an interaction with an animal in the period December 2012-December 2017 were identified from the Hybrid Electronic Medical Registry (HEMR).

The spectrum of self inflicted injuries managed at a major trauma centre in South Africa.

Background: Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay.

Quantifying the burden of trauma imaging on the CT scan service at a major trauma centre in South Africa.

Background: Imaging is an integral part of trauma management and the huge burden of trauma in South Africa places substantial pressures on radiology resources. This study aims to provide a holistic overview of the burden of trauma imaging and the cost of trauma to a busy CT scanning facility at a tertiary hospital in South Africa.

Method: We set out to describe and quantify the impact of blunt poly-trauma on CT scanning services at Grey's Hospital in Pietermaritzburg.

Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa.

Background: This study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not, and then to interrogate a number of anatomic and physiologic scoring systems to see which best predicted the need for DCS.

Methods: All patients over the age of 15 years undergoing a laparotomy for trauma during the period from December 2012 to December 2017 were retrieved from the Hybrid Electronic Medical Registry (HEMR) at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. They were divided into two cohorts, namely the DCS and non-DCS cohort, based on what was recorded in the operative note.

Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa.

Background And Aims: The management of duodenal trauma remains controversial. This retrospective audit of a prospectively maintained database was intended to clarify the operative management of duodenal injury at our institution and to assess the risk factors for leak following primary duodenal repair.

Materials And Methods: This was a retrospective study undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa.

Spectrum of injuries resulting from gunshot wounds in car hijacking: a South African experience.

Background: Car hijacking, known as "carjacking", is a form of aggravated robbery of a vehicle from the driver frequently involving firearm and is common in South Africa. There is, however, little literature on the spectrum of injuries sustained by victims of car hijacking. The study aimed to describe the spectrum of gunshot wound-related (GSW) injuries and review our experience of management of victims of car hijacking in our trauma center based in South Africa.

Laparotomy for organ evisceration from abdominal stab wounds: A South African experience.

Introduction: Organ evisceration following abdominal stab wound (SW) is currently considered as an absolute indication for mandatory laparotomy due to the high incidence of associated intra-abdominal injuries, but literature describing the spectrum of organ injury encountered is limited.

Materials And Methods: We reviewed our experience of 301 consecutive patients who were subjected to mandatory laparotomy over an eight-year period at a major trauma centre in South Africa.

Results: Of the 301 patients with organ evisceration, 92% were male (mean age: 28 years).

Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma.

Introduction: The modern concept of damage control surgery (DCS) for trauma was first introduced less than three decades ago. This audit aims to describe the spectrum and outcome of patients requiring DCS, to benchmark our experience against that reported from other centres and countries and to distil the pertinent teaching lessons from this experience.

Methods: All patients over the age of 15 years undergoing a laparotomy for trauma over the period from December 2012 to July 2016 were retrieved from the trauma registry of the Pietermaritzburg Metropolitan Trauma Service, South Africa.

The spectrum of injuries resulting from abdominal stab wounds with isolated omental evisceration: A South African experience.

Introduction: The spectrum of injury associated with anterior abdominal stab wounds (SWs) is well established. The literature in the specific setting of isolated omental evisceration is limited.

Materials And Methods: We reviewed our experience of 244 consecutive patients with established indications for laparotomy over an eight year period at a major trauma centre in South Africa.

Ethics of Burn Wound Care in a Low-Middle Income Country.

This review focuses on burn care in low- and middle-income countries (LMICs). It attempts to put the burden of disease in perspective by showing that burn care is under-resourced across the spectrum of LMICs and by interrogating the ethical dilemmas and challenges that staff face in caring for burn patients in this environment, with a focus on South Africa. More specifically, it will attempt to address the following issues: the threshold for utilizing the intensive care unit (ICU), how to balance treatment against cost, the percentage burn considered survivable and how it should be determined, the use of skin from both cadavers and living related donors, and the appropriate ethical guidelines for LMICs.

A raised serum lactate level is an independent predictor of in-hospital mortality in patients with isolated cerebral gunshot wounds.

Background: Cerebral gunshot wounds (CGSWs) represent a highly lethal form of traumatic brain injury, and triaging these patients is difficult. The prognostic significance of the serum lactate level in the setting of CGSWs is largely unknown.

Objectives: To examine the relationship between elevated serum lactate levels and mortality in patients with isolated CGSWs.

Management of intra-abdominal vascular injury in trauma laparotomy: a South African experience.

Background: Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. In light of these ongoing developments, we reviewed our contemporary experience with IAVI in an attempt to clarify and refine our management strategies and the outcome of these patients.

Methods: We retrospectively reviewed the charts of all patients admitted between January 2011 and December 2014 at a major trauma centre in South Africa who were found to have an IAVI during laparotomy for trauma.

Routine cervical spine immobilisation is unnecessary in patients with isolated cerebral gunshot wounds: A South African experience.

Objective: Routine immobilisation of the cervical spine in trauma has been a long established practice. Very little is known in regard to its appropriateness in the specific setting of isolated traumatic brain injury secondary to gunshot wounds (GSWs).

Methods: A retrospective study was conducted over a 5 year period (January 2010 to December 2014) at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa in order to determine the actual incidence of concomitant cervical spine injury (CSI) in the setting of isolated cerebral GSWs.

Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

Background: Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood.

Aims: To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI.

The effect of a concomitant renal injury on the outcome of colonic trauma.

Background: The management of colon injuries has steadily evolved over the course of the last half century. So too has the management of renal trauma. It is not clear from the literature as to whether concomitant colon and renal injuries carry increased risk of morbidity and mortality, and whether this combination of injuries necessitates a specifically tailored management approach.

The correlation between ATLS and junior doctors' anatomical knowledge of central venous catheter insertion at a major trauma centre in South Africa.

Objective: To review the ability of junior doctors (JDs) in identifying the correct anatomical site for central venous catheterization (CVC) and whether prior Advanced Trauma Life Support (ATLS) training influences this.

Design: We performed a prospective, observational study using a structured survey and asked a group of JDs (postgraduate year 1 [PGY1] or year 2 [PGY2]) to indicate on a photograph the exact site for CVC insertion via the internal jugular (IJV) and the subclavian (SCV) approach. This study was conducted in a large metropolitan university hospital in South Africa.