Morel-Lavallée lesion: What you need to know.

Abstract: The Morel-Lavallée lesion (MLL) is a rare closed degloving injury resulting from traumatic shearing forces that separate subcutaneous tissue from underlying fascia, creating a cavity filled with blood, lymph, and inflammatory exudate. Typically occurring in regions where skin can glide significantly over rigid structures, such as the thigh, MLLs present as fluctuant, boggy, sometimes painful lesions, which result from disrupted lymphatic and vascular structures. The lesion evolves through an inflammatory cascade leading to eventual encapsulation by dense fibrotic tissue.

Chest wall injury surgeon, know thyself.

The use of surgical stabilization of rib fractures (SSRF) for non-flail fracture patterns continues to rise. However, multiple, recent randomized controlled trials in this patient population have failed to show a clear benefit to surgery. Rather than widening the gap between research and practice, we must embrace these trials, learn from them, and continue to refine the indications for surgery.

Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Motorcycle crash fatalities remain a significant public health concern. Traumatic brain injury is a leading cause of death following motorcycle crash. We aim to provide evidence-based guidelines pertaining to helmet use and helmet laws with respect to important outcomes including mortality, cervical spine injury, and discharge disposition.

Posttraumatic stress disorder mitigation in trauma patients: An evidence-based systematic review from the Eastern Association for the Surgery of Trauma.

Background: Because of advances in trauma care, there has been increased survival among trauma patients. However, less progress has been made to address posttraumatic psychological disorders. Many trauma patients (19-42%) report emotional or psychological distress after injury, and over one in five will develop posttraumatic stress disorder (PTSD) and/or depression within the first postinjury year.

The effect of ridesharing services on motor vehicle crash outcomes: A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: In addition to their convenience, ridesharing applications (apps) have the potential to offer a safer transportation alternative, especially in situations involving intoxication. Their use may lead to reductions in crash-related injuries and deaths, particularly due to alcohol-impaired driving. Several observational studies have aimed to assess the impact of ridesharing on alcohol-impaired driving, crashes, and deaths.

Should we redefine the age of geriatric trauma? An insight from American College of Surgeons Trauma Quality Improvement Program database 30-day mortality risk.

Background: Older injured patients have higher mortality compared with their younger counterparts, and their outcomes worsen with each decade of life. However, the exact age to classify a patient as "geriatric" is not universally defined. Identifying an evidence-based age cutoff for "geriatric" trauma activations is important to preserve hospital and human resources by not superfluously including younger patients but also not depriving older high-risk patients of resources needed to achieve their best recovery.

Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better Outcomes than Dexmedetomidine in Hospitalized Patients.

BackgroundThis study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).MethodsThis is a retrospective cohort analysis at a single tertiary referral institution in a major urban center in the United States. In hospitalized patients above 18 years with AWS between May 1, 2018, and July 31, 2021 we compared the hospital length of stay (LOS), ICU LOS, mechanical ventilation incidence and duration of patients who received dexmedetomidine versus phenobarbital as adjuncts to lorazepam-based treatment.

Preoperative Oral Antibiotics Preparation is Associated With Improved 30-day Outcomes in Elective Colectomy for Ulcerative Colitis.

BackgroundUlcerative colitis (UC) is characterized by colonic involvement, where the 10-year risk of colectomy remains high at about 20%. The use of preoperative oral antibiotic preparation (OAP) in colectomy remains a subject of debate and there was limited evidence for UC patients. This study aimed to retrospectively investigate the relationship between OAP and 30-day outcomes following elective colectomy in UC patients using a multi-institutional national dataset.

Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients.

Background: Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability.

Chest Wall Injury Society recommendations for long-term follow-up after nonoperatively and operatively managed traumatic rib and sternal fractures.

Systematic Review/Meta-analysis; Level IV.

Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients.

Introduction: Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.

Gunshot wound causing thoracic aortic injury with bullet embolization to the common femoral artery.

Penetrating traumatic aortic injury (PTAI) is increasing in prevalence given the rise in firearm violence in the United States and is associated with significant morbidity and mortality. These injuries often result in hemorrhagic shock, with patients presenting in extremis or pulseless, traditionally requiring open approaches for repair. A rare but potentially devastating complication of firearm-related PTAI is bullet embolization.

Evaluating Racial Disparities in 30-day Outcomes for African Americans Following Colectomy for Volvulus.

Background: Surgery is the definitive treatment for colonic volvulus despite initial decompression therapy. In general surgery, African Americans were found to have higher risks of mortality and morbidities. However, racial disparity in colectomy outcomes for volvulus among African Americans had not been explored.

Tranexamic Acid Is Not Associated With a Change in Infection Risk in Trauma Patients.

Introduction: Tranexamic acid (TXA) has been used as an adjunct in traumatic hemorrhage management. Outside of trauma, TXA has been used to limit blood loss across multiple surgical fields. TXA has also been found to have an immune-modulating effect, reducing postoperative infection rates.

Hybrid 1 randomized controlled trial of an integrated stepped-care mental health intervention for traumatic injury patients.

Background: Annually, nearly 3 million individuals in the US are hospitalized after experiencing a traumatic injury (e.g., serious automobile crash, gunshot wound, stab injury).

Gunshot wound causing penetrating injury to the inferior vena cava treated with open cell self-expanding stents.

Endovascular stents are predominantly utilized for intra-arterial interventions; however, their application in managing venous injuries, especially traumatic ones, lacks comprehensive guidelines and long-term outcome studies. This case report discusses the innovative deployment of an infrarenal inferior vena cava stent for a traumatic inferior vena cava injury after a gunshot wound in a polytrauma patient. This case aims to enhance the existing evidence on the feasibility and potential outcomes of endovascular stenting in traumatic venous injuries.

Timing to surgery in elderly patients with small bowel obstruction: An insight on frailty.

Background: Small bowel obstruction (SBO) frequently necessitates emergency surgical intervention. The impact of frailty and age on operative outcomes is uncertain. This study evaluated postoperative outcomes of SBO surgery based on patient's age and frailty and explore the optimal timing to operation in elderly and/or frail patients.

An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study.

Background: The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS.

Firearms-related injury and sex: a comparative National Trauma Database (NTDB) Study.

Background: Existing study findings on firearms-related injury patterns are largely skewed towards males, who comprise the majority of this injury population. Given the paucity of existing data for females with these injuries, we aimed to elucidate the demographics, injury patterns, and outcomes of firearms-related injury in females compared with males in the USA.

Materials And Methods: A 7-year (2013-2019) retrospective review of the National Trauma Database was conducted to identify all adult patients who suffered firearms-related injuries.

Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis.

Introduction: The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The "seat belt sign" (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention.

Recent Advances in Rib Plating.

Rib fractures are a common injury in blunt trauma and are associated with high morbidity and mortality. Recent advances in surgical stabilization of rib fractures (SSRF) have led to better patient outcomes for those with highly unstable complex rib fractures, as well as those with less severe injuries. This result has been due in part to the expansion of indications for repair, as well as the development of new hardware systems to address a variety of fracture patterns and injuries.