Trauma and Emergency: Beyond Damage Control Surgery: 2nd Edition

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 3381

Special Issue Editors


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Guest Editor
Emergency and Transplant Surgery Department, University of Insubria, 21100 Varese, Italy
Interests: kidney transplantation; surgery transplantation; dialysis; oncology; immunology
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Resident surgeon at General, Emergency and Transplant Surgery Department-ASST dei Sette Laghi, via Guicciardini 9, 21100 Varese, Italy
Interests: trauma and emergency surgery; robotic surgery; visceral surgery; transplant surgery; thyroid surgery
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Resident surgeon at General, Emergency and Transplant Surgery Department-ASST dei Sette Laghi, via Guicciardini 9, 21100 Varese, Italy
Interests: surgical oncology; transplant oncology; trauma surgery; robotic surgery; visceral surgery; abdominal wall defects

Special Issue Information

Dear Colleagues,

Following the success of the first volume of our Special Issue “Trauma and Emergency: Beyond Damage Control Surgery”, we now invite high-quality submissions for volume II in the Medical Research Section. The first volume is available at https://www.mdpi.com/journal/life/special_issues/Trauma_Emergency_Surgery.

Contemporary studies on the management of severe injuries clearly indicate that patient outcomes correlate with the timeliness and appropriateness of their diagnosis and treatment. Effective management can halt the "hemorrhage-coagulopathy vicious cycle". However, the severity of the injury remains the foremost factor in determining the success of management. The "Danger model", a paradigm outlined in 2002 by Matzinger, proposes that the activation of the immune system is primarily attributed to products of damage and alarm signals emanating from injured tissues.

The varying severity of sterile post-injury inflammation and consequent organ dysfunction appears to relate to the level of immune reaction, which is consistent with the initial tissue damage caused by the trauma. A detailed understanding of these pathomechanisms could be valuable in predicting outcomes and identifying the most effective therapeutic approaches for serious trauma.

We look forward to examining recent discoveries in the area, with a specific focus on pathophysiological knowledge, diagnostic and prognostic approaches, and therapeutic strategies.

Dr. Giuseppe Ietto
Dr. Caterina Franchi
Dr. Matteo Zanchetta
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trauma surgery
  • emergency surgery
  • DAMP
  • damage-associated molecular pattern
  • post-injury inflammation
  • hemorrhage
  • transplant surgery
  • robotic surgery
  • danger model
  • PRR
  • pattern recognition receptors

Published Papers (3 papers)

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Research

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11 pages, 247 KiB  
Article
Comparative Analysis of Antithrombotic Therapy Outcomes in Mild Traumatic Brain-Injury Patients: A Focus on Bleeding Risk and Hospital-Stay Duration
by Antonio Desai, Dana Shiffer, Mauro Giordano, Alice Giotta Lucifero, Elena Generali, Francesco Reggiani, Marta Calatroni, Gabriele Savioli, Sabino Luzzi and Antonio Voza
Life 2024, 14(3), 308; https://doi.org/10.3390/life14030308 - 27 Feb 2024
Viewed by 809
Abstract
Background: Traumatic brain injury (TBI) in the elderly is a noteworthy pathology due to the exponential increase in population age, and the effects of antiplatelet and anticoagulation on patients’ outcomes are still a matter of dispute. The aim of the present study was [...] Read more.
Background: Traumatic brain injury (TBI) in the elderly is a noteworthy pathology due to the exponential increase in population age, and the effects of antiplatelet and anticoagulation on patients’ outcomes are still a matter of dispute. The aim of the present study was to evaluate the impact of various antithrombotic agents on patients with mild TBI, focusing on the risk of intracranial bleeding (ICH) and length of hospitalization (LOS). Methods: A retrospective analysis was conducted, including patients with a diagnosis of TBI admitted to the Emergency Department between 2021 and 2022. Patients were classified according to the concurrent antithrombotic therapy as aspirin (ASA), antiplatelets, direct oral anticoagulants (DOACs), and low-molecular-weight heparin (LMWH). The primary outcome was the ICH occurrence, while the secondary outcome was the LOS. The statistical analysis was performed via logistic regression models in R and STATA 13.1 software. Fisher’s exact test was used for the statistical significance. Results: 267 patients with mild TBI were included; 148 were not on antithrombotic agents, 43 were on aspirin, 33 on DOACs, 5 on LMWH, 22 on antiplatelets, and 16 on VKA. Out of the total, 9 patients experienced ICH, none of which were on DOACs, LMWH, or VKA, but 4—out of 65—were on antiplatelets, and 5—out of 148—were not on antithrombotic therapies. Patients not on antithrombotic therapy had the shortest LOS at 0.46 days, while those on VKA had the longest LOS at 1.19 days; similar trends were observed for patients on DOAC and LMWH. Conclusions: The results reveal that TBI patients on anticoagulants/antiplatelets had longer hospital stays compared with those on aspirin alone. Notably, VKA was the strongest predictor for an extended LOS. Regarding ICH, patients taking only aspirin were twice as likely to experience bleeding compared with those on anticoagulants/antiplatelets. However, to achieve statistically significant evidence, further research with a larger cohort of patients is needed. Full article
(This article belongs to the Special Issue Trauma and Emergency: Beyond Damage Control Surgery: 2nd Edition)
13 pages, 696 KiB  
Article
Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?
by Ting-Min Hsieh, Po-Chun Chuang, Chun-Ting Liu, Bei-Yu Wu, Chien-Hung Wu and Fu-Jen Cheng
Life 2024, 14(1), 16; https://doi.org/10.3390/life14010016 - 21 Dec 2023
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Abstract
The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt [...] Read more.
The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated with the shock group than with the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70–69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06–33.45) was identified as an independent predictor of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66–13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis, and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. Our results support the recommendation of emergency laparotomy in unstable patients with concomitant pelvic fractures, followed by damage control TAE if needed. Full article
(This article belongs to the Special Issue Trauma and Emergency: Beyond Damage Control Surgery: 2nd Edition)
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Review

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36 pages, 2697 KiB  
Review
Dried Plasma for Major Trauma: Past, Present, and Future
by Henry T. Peng, Kanwal Singh, Shawn G. Rhind, Luis da Luz and Andrew Beckett
Life 2024, 14(5), 619; https://doi.org/10.3390/life14050619 - 10 May 2024
Cited by 1 | Viewed by 1337
Abstract
Uncontrollable bleeding is recognized as the leading cause of preventable death among trauma patients. Early transfusion of blood products, especially plasma replacing crystalloid and colloid solutions, has been shown to increase survival of severely injured patients. However, the requirements for cold storage and [...] Read more.
Uncontrollable bleeding is recognized as the leading cause of preventable death among trauma patients. Early transfusion of blood products, especially plasma replacing crystalloid and colloid solutions, has been shown to increase survival of severely injured patients. However, the requirements for cold storage and thawing processes prior to transfusion present significant logistical challenges in prehospital and remote areas, resulting in a considerable delay in receiving thawed or liquid plasma, even in hospitals. In contrast, freeze- or spray-dried plasma, which can be massively produced, stockpiled, and stored at room temperature, is easily carried and can be reconstituted for transfusion in minutes, provides a promising alternative. Drawn from history, this paper provides a review of different forms of dried plasma with a focus on in vitro characterization of hemostatic properties, to assess the effects of the drying process, storage conditions in dry form and after reconstitution, their distinct safety and/or efficacy profiles currently in different phases of development, and to discuss the current expectations of these products in the context of recent preclinical and clinical trials. Future research directions are presented as well. Full article
(This article belongs to the Special Issue Trauma and Emergency: Beyond Damage Control Surgery: 2nd Edition)
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