Saitta Bradley, Edgington Jonathan, Hart Theodore, Wilson Kenneth, An Gary, Daccarett Miguel, Strelzow Jason
Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA.
Department of Trauma Surgery and Surgical Critical Care, University of Chicago, Chicago, IL, USA.
Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1337-1345. doi: 10.1007/s00590-019-02439-x. Epub 2019 Apr 16.
Methods of controlling hemorrhage in penetrating abdominal injuries are varied, ranging from electrocautery, ligation, laparotomy sponge packing, angiography, hemostatic agents, and direct manual pressure. Unfortunately, traditional methods are sometimes unsuccessful due to the location or nature of the hemorrhage, and manual pressure cannot be held indefinitely. We describe a novel damage control technique for hemorrhage control in these situations, followed by three cases where an external fixator vascular compressor (EFVC) was used to hold continual pressure. Three patients are presented to a Level 1 trauma center following multiple ballistic injuries, all requiring emergent exploratory laparotomy. The first had a two-pin iliac crest EFVC placed during repeat exploratory laparotomy to control bleeding. The second patient had a supra-acetabular EFVC placed during initial exploratory laparotomy after emergent embolization failed to control bleeding from the L3 vertebral body. The third patient had a two-pin iliac crest EFVC placed at initial exploratory laparotomy due to uncontrollable bleeding from the sacral venous plexus and internal iliac veins. Of the three patients, two stabilized and survived, while one passed away due to multi-organ failure. We describe a novel damage control technique that may be a useful means of temporarily stemming intraabdominal bleeding that is otherwise recalcitrant to traditional hemostatic methods. Additionally, we provided a limited case series of patients who have undergone this technique to illustrate its utility and versatility. This technique is simple, fast, effective, and adaptable to a variety of circumstances that may be encountered in patients with intraabdominal bleeding recalcitrant to conventional hemorrhage control.
控制穿透性腹部损伤出血的方法多种多样，包括电灼、结扎、剖腹术用海绵填塞、血管造影、止血剂以及直接手动压迫。不幸的是，由于出血的位置或性质，传统方法有时并不成功，而且手动压迫不能无限期维持。我们描述了一种在这些情况下控制出血的新型损伤控制技术，随后介绍了三例使用外固定器血管压迫器（EFVC）持续施压的病例。三名患者在遭受多次弹道损伤后被送至一级创伤中心，均需要紧急剖腹探查。第一例患者在重复剖腹探查期间放置了双针髂嵴EFVC以控制出血。第二例患者在紧急栓塞未能控制L3椎体出血后，在初次剖腹探查期间放置了髋臼上EFVC。第三例患者由于骶静脉丛和髂内静脉无法控制的出血，在初次剖腹探查时放置了双针髂嵴EFVC。三例患者中，两例病情稳定并存活，一例因多器官衰竭死亡。我们描述了一种新型损伤控制技术，它可能是暂时阻止腹腔内出血的有用方法，而这种出血用传统止血方法难以控制。此外，我们提供了一组接受该技术治疗的患者的有限病例系列，以说明其实用性和通用性。该技术简单、快速、有效，适用于腹腔内出血难以用传统方法控制的患者可能遇到的各种情况。
