European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2023
Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and haemorrhagic shock in a pre-clinical porcine model.
In military trauma, disaster medicine, and casualties injured in remote locations, times to advanced medical and surgical treatment are often prolonged, potentially reducing survival and increasing morbidity. Since resuscitation with blood/blood components improves survival over short pre-surgical times, this study aimed to evaluate the quality of resuscitation afforded by blood/blood products or crystalloid resuscitation over extended 'pre-hospital' timelines in a porcine model of militarily relevant traumatic haemorrhagic shock. ⋯ When times to advanced medical care are prolonged, resuscitation with blood/blood components is recommended over saline due to the superior quality and stability of resuscitation achieved, which are likely to lead to improved patient outcomes.
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Eur J Trauma Emerg Surg · Feb 2023
The use of a modified posterior approach (SPAIRE) may be associated with an increase in return to pre-injury level of mobility compared to a standard lateral approach in hemiarthroplasty for displaced intracapsular hip fractures: a single-centre study of the first 285 cases over a period of 3.5 years.
A tendon-sparing modification of the posterior approach to the hip joint was introduced in the specialist hip unit at our institution in 2016. The SPAIRE technique-acronym for "Saving Piriformis And Internus, Repair of Externus" preserves the insertions of gemellus inferior, obturator internus, gemellus superior and piriformis intact. We compare the results of the first 285 hip hemiarthroplasty patients, unselected but preferentially treated by our hip unit surgeons using the SPAIRE technique, with 567 patients treated by all orthopaedic surgeons (including the hip unit) in the department over the same 3.5 year period using the standard lateral approach. We report length of stay, return to pre-injury level of mobility, place of residence and mortality at 120 days. ⋯ When used in hip hemiarthroplasty, the SPAIRE technique appears safe and may confer benefit in maintaining the pre-injury level of mobility over the standard lateral approach.
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Eur J Trauma Emerg Surg · Feb 2023
Intensive hands-on microsurgery course provides a solid foundation for performing clinical microvascular surgery.
Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching expertise and/or facilities. The aim of this manuscript was to describe the methodology and clinical effectiveness of an international microsurgery course, currently taught year-round in eight countries. ⋯ Microvascular surgery requires highly specialized and individualized training to achieve the competences required to perform and master the delicate fine motor skills necessary to successfully handle and anastomose very small and delicate microvascular structures. The ever-expanding clinical applications of microvascular procedures has led to an increased demand for training opportunities. By teaching time-tested basic motor skills that form the foundation of microsurgical technique this international microsurgery-teaching course is helping to meet this demand.