A Rare Injury to the Ascending Aorta After Blunt Trauma.

Blunt aortic injuries are life-threatening and overwhelmingly occur in the proximal descending aorta. On the contrary, injury to the ascending aorta after blunt trauma is rare. We report a case of a circumferential ascending aortic injury in a previously healthy 57-year-old man involved in a motor vehicle collision.

The Characteristics and Results of Endovascular Devices in Trauma (CREDiT) study: Multi-institutional results.

Introduction: Endovascular techniques are increasingly used to repair major traumatic vascular injuries, but most endovascular implants are not designed/approved for trauma-specific indications. No inventory guidelines exist for the devices used in these procedures. We aimed to describe the use and characteristics of endovascular implants used for repair of vascular injuries to allow for better inventory management.

Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used in some trauma settings. Arterial access-related limb ischemic complications (ARLICs) resulting from the femoral arterial access required for REBOA are largely under reported. We sought to describe the incidence of these complications and the clinical, technical, and device factors associated with their development.

Blunt cerebrovascular injuries: Outcomes from the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) multicenter registry.

Background: Administering antithrombotics (AT) to the multiply injured patient with blunt cerebrovascular injury (BCVI) requires a thoughtful assessment of the risk of stroke and death associated with nontreatment. Large, multicenter analysis of outcomes stratified by injury grade and vessel injured is needed to inform future recommendations.

Methods: Nine hundred and seventy-one BCVIs were identified from the PROspective Vascular Injury Treatment registry in this retrospective analysis.

Increasing age is associated with worse outcomes in elderly patients with severe liver injury.

While the incidence of geriatric trauma continues to increase, outcomes following severe blunt liver injury (BLI) are unknown. We sought to investigate independent predictors of mortality among elderly trauma patients with severe BLI. A retrospective study of the NTDB (2014-15) identified patients with isolated, high-grade BLI.

Age is a predictor for mortality after blunt splenic injury.

Background: While the incidence of geriatric trauma continues to increase, the management of high-grade blunt splenic injury (BSI) in the elderly remains controversial. Among this population, data evaluating survival rates following non-operative and operative management are inconsistent. We analyzed mortality risk in geriatric patients with high-grade BSI based on operative vs.

Delayed presentation of pericardio-diaphragmatic hernia following blunt trauma: A case report.

Pericardio-diaphragmatic hernias (PDHs) are exceedingly rare. When found in adults, they are most commonly caused by blunt trauma and require immediate repair. We report a case of a 61-year-old female who presented with shortness of breath, chest pain and fatigue one month after a motor vehicle collision.

Variability in Discharge Disposition Across US Trauma Centers After Treatment for High-Energy Lower Extremity Injuries.

Objective: To evaluate the association between patient- and center-level characteristics and discharge to an inpatient facility versus home after treatment for lower extremity trauma, as well as examine the variability in discharge disposition across clinical centers after controlling for these factors.

Design: This is an analysis of data collected prospectively across 5 multicenter studies of extremity trauma.

Setting: US Trauma Centers.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an Option for Uncontrolled Hemorrhagic Shock: Current Best Practices and Anesthetic Implications.

Noncompressible torso hemorrhage is reported to be a leading cause of potentially preventable mortality in both civilian trauma victims and military combat casualties. This hemorrhage may come from venous, arterial, or additional combined sources in the chest, abdomen, pelvis, axilla, or groin regions. Aortic occlusion as an adjunct to strategies for trauma damage control can decrease the amount of bleeding distal to the occluded site and provide a time-sensitive opportunity for resuscitation and definitive hemorrhage control.

Multi-Scale Attentional Network for Multi-Focal Segmentation of Active Bleed after Pelvic Fractures.

Trauma is the worldwide leading cause of death and disability in those younger than 45 years, and pelvic fractures are a major source of morbidity and mortality. Automated segmentation of multiple foci of arterial bleeding from ab-dominopelvic trauma CT could provide rapid objective measurements of the total extent of active bleeding, potentially augmenting outcome prediction at the point of care, while improving patient triage, allocation of appropriate resources, and time to definitive intervention. In spite of the importance of active bleeding in the quick tempo of trauma care, the task is still quite challenging due to the variable contrast, intensity, location, size, shape, and multiplicity of bleeding foci.

Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma.

Importance: Numerous studies have demonstrated that long-term outcomes after orthopedic trauma are associated with psychosocial and behavioral health factors evident early in the patient's recovery. Little is known about how to identify clinically actionable subgroups within this population.

Objectives: To examine whether risk and protective factors measured at 6 weeks after injury could classify individuals into risk clusters and evaluate whether these clusters explain variations in 12-month outcomes.

The Psychology of Scars: A Mini-Review.

Scars can result from a range of causes: accidents, surgery, and even acne. The resultant change in appearance can negatively affect body image and self-confidence. Scarring is stigmatised in society because of the premium placed on beauty - disfigurement or unsightly features are still used to portray evil in horror films, comic strips, and fairy tales.

Defining the burden, scope, and future of vascular acute care surgery.

Objective: The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland.

Multi-modality imaging of the leaking ureter: why does detection of traumatic and iatrogenic ureteral injuries remain a challenge?

Ureteral injuries are uncommon in trauma patients, accounting for fewer than 1% of all injuries to the urinary tract. These uncommon, yet problematic, injuries can often be overlooked in the standard search pattern on abdominal and pelvic multi-detector CT (MDCT) images, as radiologists focus on more immediate life-threatening injuries. However, early diagnosis and management are vital to reduce potential morbidity.

Incomplete Lemierre syndrome.

An invasive Fusobacterium infection may originate from an apparent routine pharyngitis and lead to significant distant septic complications. Even without internal jugular thrombosis, the same mechanism of disease exists, and therefore, the same morbidity, prognosis, and treatments are applicable, hence the suitable term incomplete Lemierre syndrome. We present a case of invasive Fusobacterium infection that meets all criteria for Lemierre syndrome except lacking internal jugular thrombosis.

Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients.

Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death.

Design: Retrospective study.

Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport.

Background: Recent studies suggest that mode of transport affects survival in penetrating trauma patients. We hypothesised that there is wide variation in transport mode for patients with gunshot wounds (GSW) and there may be a mortality difference for GSW patients transported by emergency medical services (EMS) vs. private vehicle (PV).

An anatomical study of external carotid artery vascular territories in face and midface flaps for transplantation.

Background: The technical success of facial composite tissue allotransplantation demands full understanding of superficial and deep perfusion for reliable microvascular transfer. Candidates with composite midface defects require an appreciation of the circulatory patterns to design a composite midface allotransplant.

Methods: External carotid vascular territories were evaluated in 10 cadavers to determine the reliability of facial soft-tissue flaps based on a single vascular pedicle.