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Abdominal evisceration after blunt trauma is uncommon and rarely survivable when coupled with a concomitant iliac vascular injury. Blunt abdominal injury is rarely a cause of abdominal evisceration but may, on occasion, present in patients affected by a unique or high-energy traumatic injury. In these instances, major vascular injury is exceedingly rare but is associated with a high mortality rate. Damage to important vessels that may present more subtly, such as iliac arterial injury, can still be lethal and are important to evaluate in the trauma workup for blunt evisceration. We report the case of a 20-year-old woman who survived an abdominal wall and vascular injury in a motor vehicle accident. Management of this unusual association is discussed.

IntroductionPediatric lower extremity vascular injuries (LEVI) are rare but can result in significant morbidity. We aimed to describe our experience with these injuries, including associated injury patterns, diagnostic and therapeutic challenges, and outcomes.MethodsThis was a retrospective review at a single level 1 trauma center from January 2000 to December 2019. Patients less than 18 years of age with LEVI were included. Demographics, injury patterns, clinical status at presentation, and intensive care unit (ICU) and hospital length of stay (LOS) were collected. Surgical data were extracted from patient charts.Results4,929 pediatric trauma patients presented during the 20-year period, of which 53 patients (1.1%) sustained LEVI. The mean age of patients was 15 years (range 1–17 years), the majority were Black (68%), male (96%), and most injuries were from a gunshot wound (62%). The median Glasgow Coma Scale score was 15, and the median Injury Severity Score was 12. The most commonly injured arteries were the superficial femoral artery (28%) and popliteal artery (28%). Hard signs of vascular injury were observed in 72% of patients and 87% required operative exploration. There were 36 arterial injuries, 36% of which were repaired with a reverse saphenous vein graft and 36% were repaired with polytetrafluoroethylene graft. One patient required amputation. Median ICU LOS was three days and median hospital LOS was 15 days. There were four mortalities.ConclusionPediatric LEVIs are rare and can result in significant morbidity. Surgical principles for pediatric vascular injuries are similar to those applied to adults, and this subset of patients can be safely managed in a tertiary specialized center.Level of evidenceLevel IV, retrospective study.

Fatal lower level falls commonly result from ladder fall injuries (LFIs), an often-avoidable injury. We hypothesized that older patients’ injury severity differs from younger patients falling from the same mechanism with fall height determining overall morbidity. A retrospective review was completed of all traumatic LFIs during a 6-year period resulting in 178 patients. The mean LFI height was 10.9 ± 6.0 feet, the majority being male (87%), with a mean age of 50.7 ± 16.6 years. The mean ISS was 7.7 ± 7.0 (range, 1–38), 23.6% sustaining > 1 injury. Age inversely correlated with the mean LFI height with patients ≥66 years falling from significantly lower heights (12.3 ft For age group 18–45 y; 10.4 ft vs 9.0 ft (p = 0.003) and having longer LOS (7.3 vs 3.8 days, P = 0.011). No difference in ventilator requirement/days, blood product requirements, or mortality among age groups was observed. Geriatric patients sustain similar injury patterns at lower height levels compared to all ages. Injury prevention programs are necessary to reduce the incidence of a commonly preventable injury. •The likelihood of requiring ICU admission increases with those ages ≥ 66 years.•Age inversely correlates with ladder fall height.•One-third of patients ≥ 66 years of age sustain a head injury following ladder falls.

The role of mandatory exploration and repair of low-grade penetrating carotid injuries is unclear. We aim to compare outcomes of those managed non-operatively and operatively. A single-center retrospective (1/2012–12/2023) review of penetrating common carotid (CCA) and internal carotid arteries (ICA) was performed. Low-grade injuries were defined as intimal dissections and intramural hematomas. Patients with low-grade injuries managed non-operatively and operatively were compared. There were 54 patients with 62 low-grade injuries. Ten patients underwent operative management, of which 90 ​% had non-therapeutic vascular explorations. One patient expired due to neurologic decline and herniation. Of the 44 patients managed non-operatively, none expired due to a decline in their neurologic exam. There was no difference in stroke rates between the groups. Stroke rates were similar between non-operatively and operatively managed low-grade penetrating CCA and ICA injuries. CT imaging should be considered in stable patients with penetrating neck trauma to characterize their vascular injury, as low-grade injuries may be managed non-operatively without significant sequelae. •There was no difference in stroke rate between operative vs non-operative management of low-grade ICA and CCA injuries.•If low-grade injury on CT and no aerodigestive injury, management can proceed without vascular neck exploration.•Low-grade penetrating ICA and CCA injuries can be safely managed non-operatively.

The patient was noted to be afebrile with leukocytosis of 19.5 K/mm3, C-reactive protein of 23.50 mg/ dL, erythrocyte sedimentation rate of 132 mm/hour, and a serum glucose of 365 mg/dL on admission. Because of concern for necrotizing fasciitis, the patient underwent incision and drainage with wound vacuum placement. After the initial excisional debridement and drainage procedure, a second left foot debridement was completed, which revealed a 10 x 10-cm open, gangrenous nonhealing diabetic wound with exposed tendon overlying the 3rd ray. [...]an ECM-type urinary bladder matrix (UBM, ACell Inc., Columbia MD ©), Cytal® Wound Matrix 6-layer UBM (10 x 15 cm), and MicroMatrix® particles were applied in conjunction with negative pressure wound therapy (also called vacuum-assisted wound closure) at 75 mmHg. negative pressure wound therapy was changed weekly thereafter with hydration of UBM with water-soluble lubricant on discharge. The acellular scaffold and growth factors provide the necessary structural support and signaling to promote wound regeneration and remodeling. [...]UBM coupled with excisional debridement to viable tissue is effective for tissue regeneration and supported in the current literature.

Background We hypothesized that trauma surgeons can safely selectively manage traumatic craniomaxillofacial injuries (CMF) without specialist consult, thereby decreasing the overall cost burden to patients. Methods A 4-year retrospective analysis of all CMF fractures diagnosed on facial CT scans. CMF consultation was compared with no-CMF consultation. Demographics, injury severity, and specialty consultation charges were recorded. Penetrating injuries, skull fractures, or patients completing inpatient craniofacial surgery were excluded. Results 303 patients were studied (124 CMF consultation vs 179 no-CMF consultation), mean age was 47.8 years, with 70% males. Mean Glasgow Coma Scale and Injury Severity Score (ISS) was 14 ± 3.4 and 10 ± 9, respectively. Patients with CMF consults had higher ISS (P < .001) and needed surgery on admission (P < .001), while no-CMF consults had shorter length of stay (P < .002). No in-hospital mortality or 30-day readmission rates were related to no-CMF consult. Total patient charges saved with no-CMF consultation was $26 539.96. Discussion Trauma surgeons can selectively manage acute CMF injuries without inpatient specialist consultation. Additional guidelines can be established to avoid tertiary transfers for specialty consultation and decrease patient charges.

Data Age at presentation, mean years (SD) [range] 51 (18.5) [24-82] Sex Male, n (%) 12 (92.3) Race White, n (%) 11 (84.6) Mechanism Motor vehicle collision, n (%) 4 (30.8) Motorcycle collision, n (%) 3 (23.1) Moped collision, n (%) 1 (7.7) Boat collision, n (%) 1 (7.7) Fall, n (%) 4 (30.8) Emergent surgery Damage control laparotomy, n (%) 4 (30.8) Craniectomy, n (%) 1 (7.7) ISS at presentation, mean (SD) [range] 30.5 (14.9) [17-41] GCS score at presentation, mean (SD) [range] 13.2 (2.9) [7-15] Hospital stay, mean days (SD) [range] 67 (145.4) [3-533] ICU admission, n (%) 10 (76.9) ICU days, mean (SD) [range] 12 (17) [3-55] Ventilatory support, n (%) 9 (69.2) Ventilatory days, mean, n (SD) [range] 74 (116.7) [3-516] Abbreviations: ISS, Injury Severity Score; GCS, Glascow Coma Score Scale; ICU, intensive care unit. Data Concomitant infection, N (%) 8 (62) Open fracture, n (%) 5 (38) Albumin (mg/dL) mean (SD) [range] 2.3 (0.78) [1.4-3.8] Prealbumin (mg/dL) mean (SD) (range)] 11 (5.2) [4-18] CPK (U/L), mean (SD) [range] 8478 (9 849) [212 – 23 461] Transfusion requirements, n (%) 10 (76.9) Total red blood cells units, mean (SD) 103, 10.3 (7.8) Total fresh frozen plasma units, mean (SD) 43, 7.1 (8.2) Total platelets units, mean (SD) 17, 3.4 (2.7) Total cryoprecipitate units, mean (SD) 4, 2 (1.4) Abbreviation: CPK, creatine phosphokinase. Like other studies, we found the most commonly implicated traumatic injuries among our patient group to be motor vehicle collisions. 1 Prior research has identified risk factors and indicators that furnish a predictive value for estimating infectious complications in trauma patients: rhabdomyolysis, open, grossly contaminated comminuted fractures, massive blood transfusion, ISS >15, penetrating abdominal trauma, and retained orthopedic hardware.1,4 Our patients with positive Aspergillus isolates had similar risk factors for such infectious complications.

Minimal literature correlates stroke rates in blunt cerebrovascular injury (BCVI) to bilaterality, multi-vessel injury, or multifocal injury. We hypothesized that a synchronous cerebrovascular injury and a higher-grade injury would increase stroke rates. A single-center retrospective (1/2016-12/2023) review was conducted identifying patients with BCVI. Injury characteristics, clinical features, and demographic data were collected and statistically modeled in relation to stroke risk. Stroke rate in our cohort was 3.7 ​%. Higher-grade injuries increased the odds of stroke in carotid and vertebral BCVIs. The odds of stroke also increased with combined carotid and vertebral BCVIs versus isolated vertebral injury (OR 3.9 [1.4–10.2]), but not with bilateral carotid (OR 1.5 [0.5–3.9]) or vertebral injuries (OR 1.0 [0.3–2.8]). Our findings support previous data on the relationship between BCVI grade and stroke risk; however, combined vertebral and carotid injuries may also increase the risk. •Higher-grade injuries increase the odds of stroke in both carotid and vertebral BCVI.•Combined carotid and vertebral BCVI increase the odds of stroke.•Bilaterality of carotid or vertebral BCVI does not impact stroke risk.•Antiplatelet/anticoagulant prophylaxis may help prevent strokes in patients with carotid BCVI.

Background Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality. Emergency general surgery (EGS) patients comprise 7% of hospital admissions in America with a reported rate of VTE of 2.5%. Of these, >69% required hospital readmission, making VTE the second most common cause for readmission after infection in EGS patients. We hypothesize a correlation between body mass index (BMI) and VTE in EGS patients. Methods The American College of Surgeons National Surgery Quality Improvement Database (NSQIP) was queried from January 2015 to December 2016. 83 272 patients met inclusion criteria: age ≥18 and underwent an EGS procedure. Patients were stratified by BMI. Descriptive statistics were used for demographic and numerical data. Categorical comparisons between covariates were completed using the chi-square test. Continuous variables were compared using Student’s t-test, Mann Whitney U-test, or Kruskal-Wallis H test. Results 83 272 patients met the inclusion criteria. 1358 patients developed VTE (903 deep vein thrombosis (DVT) only, 335 pulmonary embolism (PE) only, and 120 with DVT and PE). Morbidly obese patients were 1.7 times more likely to be diagnosed with a PE compared with normal BMI (P = .004). Increased BMI was associated with the co-diagnosis of PE and DVT (P = .027). Patients with BMI <18.5 were 1.4 times more likely to experience a VTE compared with normal BMI (P = .018). Patients with a VTE were 3.2 times more likely to die (P < .001) and less likely to be discharged home (P < .001). Discussion Our study found that obese and underweight EGS patients had an increased incidence of VTE. Risk recognition and chemoprophylaxis may improve outcomes in this population.

Patient demographics, alcohol use, loss of consciousness, helmet use, Glasgow Coma Scale score, Injury Severity Score (ISS), Abbreviated Injury Scale, hospital length of stay (LOS), ICU LOS, ventilator days, traumatic brain injury, and mortality were recorded. In a pool of MC trauma data from 11 states over five years, rates of head and facial trauma, traumatic brain injuries, and death were significantly higher in partial law states than universal law states.4 Given the significant injuries associated with operating MCs and MPs and the aforementioned laxity regarding helmet laws, a tangible and cost-effective solution to decrease resource utilization and mortality in all two-wheeled motorized vehicle trauma could be a universal helmet law. [...]although MPs have lower speeds with subsequent lax regulations and high-risk vulnerable riders, traumatic injuries are similar to those associated with MC use, in particular with regard to head injuries and overall mortality.