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Imaging for the Evaluation and Treatment of Vascular Trauma

Background The evolution of imaging for the diagnosis and treatment of vascular injury has evolved with the development of imaging technologies, increased availability of advanced modalities, and changing treatment paradigms. Diagnostic arteriography was first used in 1927 by Egas Moniz, a neurologist. The technique for percutaneous access and catheter exchange over a wire was developed in 1953 by Sven-Ivar Seldinger, a radiologist. For a time, radiology…

Diagnosis of Vascular Injury

Introduction Vascular trauma presents in a variety of settings and results in findings that range from life-threatening hemorrhage secondary to major torso or extremity vessel disruption to no detectable signs in occult injuries. Effective management is based upon early diagnosis and prompt treatment. Isolated vascular injuries are becoming less common at modern urban trauma centers. There is a growing prevalence of multisystem trauma that includes vascular…

Damage Control and Immediate Resuscitation for Vascular Trauma

Introduction Hemorrhage occurs when there is disruption of the blood vessel wall after an injury, i.e., vascular trauma. Hemorrhage remains a leading cause of death in trauma patients, accounting for 40% of deaths. In order to reduce mortality from hemorrhage there must be early and effective control of the bleeding, with concurrent replacement of blood volume. There remains debate as to the most effective fluid with…

Prehospital Management of Vascular Injury

Introduction Major hemorrhage is the leading cause of preventable death in both civilian and military trauma patients. However, since the beginning of the twenty-first century improvements have been made in the care of trauma patients with major hemorrhage. For the purposes of this chapter the terms vascular injury and major hemorrhage will be used interchangeably. These improvements are, perhaps, best demonstrated by examining the survival of…

Training Paradigms for Vascular Trauma

Introduction The issue of surgical training—whether vascular or general—faces a number of significant current and future challenges. Firstly, the advent of vascular surgical residencies in the United States and Great Britain has widened the gap between vascular surgery and general surgery as specialties, and it has specifically limited the exposure of vascular surgeons to major trauma and constrained the general surgeons experience with regard to the…

Systems of Care in the Management of Vascular Injury

Trauma Systems Overview Managing severe injuries requires the timely intervention of multidisciplinary teams, as well as the coordination of prehospital care and resuscitation begun at the point of injury. Fundamentally, trauma systems save lives by rapidly delivering critically injured patients in optimal condition to specialist surgical teams. The delivery of these patients to specialized trauma centers has repeatedly demonstrated significant reductions in mortality compared with non-specialist…

Epidemiology of Vascular Trauma

Lambert’s dictum describes “what” vascular surgeons do. This has remained constant throughout the centuries. However, “why” and “how” surgeons do this has changed drastically from decade to decade. The vascular trauma subspecialty in particular has experienced changing practices with regard to fluid versus blood products resuscitation, tourniquet use, point-of-care imaging and endovascular innovations, such as REBOA and the covered stent. The true purpose of epidemiological study…

The Vascular Injury Legacy

Although the first crude arteriorrhaphy was performed more than 250 years ago, it is only within the past 50 years that vascular surgery has been practiced both widely and consistently with anticipation of good results. Historically, it is of particular interest that by the turn of the 20th century, many if not most of the techniques of modern vascular surgery had already been explored through extensive…

Global surgery and anaesthesia

Defining Global Surgery The concept of global surgery has gained prominence in public health discourse over the past decade. Although traditional issues in global health continue to attract attention, global surgery as a discipline is now an integral part of the dialogue. Global surgery has been defined as ‘an area of study, research, practice and advocacy that seeks to improve health outcomes and achieve health equity…

Orthopaedic surgery

Introduction Orthopaedic surgery involves the assessment and management of a wide spectrum of common conditions that affect bones, joints and soft tissues. The focus of this chapter is the assessment and management of degenerative and inflammatory joint diseases; bone and joint infection; congenital and developmental (growing skeleton) conditions; soft tissue and bone tumours; and trauma. Assessment almost always begins with history and examination, and is frequently…

Ear, nose and throat surgery

Ear Anatomy External ear The external ear lies lateral to the tympanic membrane. The pinna ( Fig. 27.1 ) is made of fibroelastic cartilage, the external auditory meatus has an outer cartilage portion and the inner part is formed by the tympanic bone ( Fig. 27.2 ). It is lined by squamous epithelium and contains ceruminous glands that produce wax. There is very little subcutaneous tissue,…

Transplantation surgery

Introduction Solid organ transplantation is a lifesaving and life-enhancing treatment for many patients with organ failure. For many patients with end-stage renal failure (ESRF), kidney transplantation improves quality of life (QOL) and confers survival benefits ( EBM 26.1 ). Liver, heart and lung transplantation can be truly lifesaving, as there are few alternatives. The two main obstacles to transplantation are overcoming the recipient’s immune response and…

Neurosurgery

Introduction The scope of neurosurgical operations continues to evolve with advances in such domains as imaging, anaesthesia, instrumentation, microsurgery, endoscopy and frameless image guidance, all of which contribute to reduced operative mortality and morbidity. There are many areas of continuing controversy, and much of neurosurgery still lacks a quality evidence base to guide management. The results of randomised controlled trials (RCTs) have usually led to significant…

Urological surgery

Assessment General points Patients may present with symptoms clearly related to the urinary tract, but seemingly unrelated symptoms may also be due to a urologic cause, such as backache from metastatic prostatic carcinoma, fever of unknown origin from renal carcinoma, or lethargy and anaemia from obstructive renal failure. Urinary tract symptoms Pain Afferent innervation of the urinary tract is rudimentary, and pain originating from these organs,…

Cardiothoracic surgery

Introduction Cardiothoracic surgery is one of the newer surgical specialities that has undergone massive expansion and subspecialisation in the last few years. Although these could be considered two distinct specialities, cardiac and thoracic surgery remain closely related with common pathologies and practices. Symptoms of cardiothoracic disease Pain The classical pain of coronary artery disease (CAD) is normally central crushing chest pain radiating to the jaw or…

Vascular and endovascular surgery

Introduction Vascular surgery is a subspecialty of surgery dedicated to diseases and disorders of the circulation. It is delivered by a multidisciplinary team of vascular surgeons, interventional radiologists, anaesthetists, physicians (angiologists), nurses, physiotherapists and occupational therapists. Despite a reduction in smoking in many high-income countries countries, the burden of arterial and venous disease is likely to grow as the population ages and the prevalence of diabetes…

Endocrine surgery

Introduction In surgical endocrine disease, thyroid disorders are common, adrenal disease is uncommon and parathyroid disease is rare. Thyroid gland Surgical anatomy and development The thyroid gland develops from the thyroglossal duct, which grows downwards from the pharynx through the developing hyoid bone. On the front of the trachea, the duct bifurcates and fuses with elements from the fourth branchial arch, from which the parafollicular (C)…

Breast surgery

Anatomy and physiology of the breast The breast is a modified sweat gland made up of glandular tissue, fibrous supporting tissue and fat. Its purpose is to produce milk, but it also has a significant role in female sexual and personal identity. During puberty in females, development of the adult breast (thelarche) begins under the influence of oestrogen and progesterone. Following initial proliferation of ducts and…

Plastic surgery, including common skin and subcutaneous lesions

Introduction Reconstructive plastic surgery, as opposed to cosmetic surgery, is concerned with the restoration of form and function following trauma, ablative surgery, necrotising infection or congenital anomaly. The various techniques by which this is achieved are applicable throughout the body, whether male or female, young or old, and the plastic surgeon must therefore have an excellent knowledge of applied anatomy and reconstructive techniques. The ‘reconstructive ladder’…