No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review.
Humans; chemoprophylaxis; Deep vein thrombosis; Mechanical prophylaxis; Pulmonary embolism; Ultrasound surveillance; Venous thromboembolism; Lower Extremity; Wounds and Injuries/*complications; Multiple Trauma/*complications; Pulmonary Embolism/etiology/*mortality; Venous Thrombosis/etiology/*mortality
PURPOSE: To assess the effect of surveillance on deep vein thrombosis (DVT) and pulmonary embolism (PE) rates, the efficacy of chemoprophylaxis and mechanical prophylaxis, and the relationship between DVT and PE. METHODS: A 23 year, systematic literature review was performed in PubMed. Twenty publications with > 13,000 patients were reviewed. Analyzed traits included: DVT surveillance utilization, the total number of patients included in each study, the number of patients developing DVT and/or PE, chemoprophylaxis and mechanical prophylaxis utilization. When event proportions from individual studies were combined, a weighted mean proportion was computed based on the size of each individual cohort. Combined event proportions were compared with other combined event proportions, according to differences in intervention. Inter-group event proportions were compared using Chi-Square or Fisher's exact test, as appropriate. RESULTS: DVT rates increase with surveillance (10.7% vs. 2.5%, p < 0.001). PE rates were similar regardless of surveillance (p = 1.0). Chemoprophylaxis lowered both DVT rates (8.2% vs. 10.7%; p < 0.0001) and PE rates (1.2% vs. 1.9%; p = 0.0050). Mechanical prophylaxis did not decrease DVT rates (10.2% vs. 11.5%; p = 0.2980) or PE rates (1.7% vs. 1.6%; p = 1.0). In patients with neither chemoprophylaxis nor mechanical prophylaxis, DVT rate was 11.5%, PE was 1.6%. When chemoprophylaxis and/or mechanical prophylaxis were given, DVT rate was 8.6% (p < 0.0189) and PE was 1.3% (p = 0.4462). PE proportions were not decreased with mechanical prophylaxis or surveillance. DVT and PE rates were not associated (p = 0.7574). CONCLUSIONS: The results suggest that PE is not associated with lower extremity DVT in adult trauma patients.
Aziz Hiba Abdel; Hileman Barbara M; Chance Elisha A
European journal of trauma and emergency surgery : official publication of the European Trauma Society
2018
2018-12
<a href="http://doi.org/10.1007/s00068-018-1043-3" target="_blank" rel="noreferrer noopener">10.1007/s00068-018-1043-3</a>
Robotic harvest of the rectus abdominis muscle: a preclinical investigation and case report.
*Robotics; Adult; Cadaver; Dissection; Female; Free Tissue Flaps; Humans; Limb Salvage; Lower Extremity; Minimally Invasive Surgical Procedures; Muscle Neoplasms/*therapy; Rectus Abdominis/*surgery; Sarcoma/*therapy; Tissue and Organ Harvesting/*methods; Wounds and Injuries/*surgery
In an attempt to decrease donor-site morbidity for rectus abdominis muscle harvest during free tissue transfer, we developed a technique of minimally invasive harvest. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in two cadavers for dissection and harvest of four rectus abdominis muscles. After the cadaver dissections were performed, the technique was used in a 30-year-old woman to harvest the left rectus abdominis muscle for free tissue transfer to a lower extremity defect. Four cadaver dissections for harvest of the rectus abdominis muscle using the da Vinci Surgical System were performed. In the cadavers and actual case, three ports (11 mm, 11 mm, and 15 mm) were used to access the abdominal cavity and perform the dissection. An additional 3 cm incision was used to remove the muscle from the abdominal cavity. The patient has not developed any surgical-site morbidity, including bulge or hernia in the 6 months postprocedure. Minimally invasive harvest of the rectus abdominis muscle is possible with the assistance of the da Vinci Surgical System. Potential benefits may include decreased surgical-site morbidity. Also, this may provide an approach to minimally invasive transperitoneal reconstruction.
Patel Niyant V; Pedersen John C
Journal of reconstructive microsurgery
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1055/s-0031-1287674" target="_blank" rel="noreferrer noopener">10.1055/s-0031-1287674</a>