Trauma Surgery: Volume 2: Thoracic and Abdominal Trauma

327 Pages·2013·5.32 MB·English

by  Salomone Di Saverio

S. Di Saverio · G. Tugnoli · F. Catena
L. Ansaloni · N. Naidoo Editors
Trauma Surgery
Volume 
Thoracic and
Abdominal Trauma
Forewords by
Kenneth Mattox and Franco Baldoni
123
Trauma Surgery

S. Di Saverio (cid:129) G. Tugnoli (cid:129) F. Catena
L. Ansaloni (cid:129) N. Naidoo
Editors
Trauma Surgery
Volume 2
Thoracic and Abdominal Trauma
Editors
Salomone Di Saverio Luca Ansaloni
Trauma Surgery Unit Department of General
Maggiore Hospital Regional and Emergency Surgery
Trauma Center, AUSL Bologna Papa Giovanni XXIII Hospital
Bologna, Italy Bergamo , Italy
Gregorio Tugnoli Noel Naidoo
Trauma Surgery Unit Department of Surgery
Maggiore Hospital Regional Nelson R Mandela School of Medicine
Trauma Center, AUSL Bologna University of KwaZulu-Natal
Bologna, Italy Durban , South Africa
Department of Surgery
Fausto Catena
Port Shepstone Regional Hospital
Emergency and Trauma Surgery
Durban , South Africa
Department
Maggiore Hospital of Parma
Parma , Italy
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I SBN 978-88-470-5458-5 ISBN 978-88-470-5459-2 (eBook)
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With deep gratitude I’d like to dedicate this work to the
memory of my father, Tito, who recognized my inclinations
early on, encouraged and supported me with wonderful
enthusiasm and intelligence in my pursuit of a medical and
surgical career. His constant presence in my youth, his
optimism, his simple and honest life are for me still a source
of pride and a never ending model for life, being a star
from the sky, shining brightly to give me a safe and fatherly
guidance!
I also thank and dedicate to my mother, Gabriella, who
has always been the beacon of light guiding me morally and
culturally. She is a brilliant combination of religious faith
and classical learning who supported me in my commitment
to research and science. She remains my mentor in logic and
humanities, sharing the wisdom of her beloved Greek and
Latin masters.
I am also grateful and dedicate to my devoted wife
Omeshnie from South Africa, a professional nurse whom I
met during my experience overseas as a trauma surgeon.
She constantly supports me and every day she is sharing our
life together with patience and love.
Salomone
To my mum and dad, for all they have done for me.
To Luisa, Francesca and Alessandro, with all my love.
To my young grandson Federico, with my best wishes for
his future life.
Gregorio
To all world Emergency Surgeons: brave and good people
Fausto
To my amazing parents Gina and Atchiah Naidoo and my
family
Noel
Foreword
It is a distinct honor to acknowledge this work in trauma surgery
by Doctors Di Saverio, Tugnoli, Catena, Ansaloni and Naidoo,
who serve as its writers and editors. T rauma Surgery: Volume
2 – Thoracic and Abdominal Trauma , published by Springer, is
timely and appropriate. This is the 2nd volume of a multivolume
textbook on trauma surgery, the 1st volume already in print and
focusing on trauma management, trauma and critical care,
orthopaedic trauma and neuro-trauma. These volumes are edited
by the same surgeons. This 2nd volume contains 22 chapters
focusing on the clinical management of different organ systems,
and each chapter is written by internationally recognized sur-
geons. The combination of subject matter and authors bespeak
the high aims of this textbook.
This textbook appears on the market at a time when “trauma”
is recognized as a major public health issue around the world.
The major cause of preventable death from trauma continues to
be uncontrollable hemorrhage. The major body cavities where
hemorrhage is uncontrollable are the chest and abdomen, the
focus of this book. Several of the chapters specifically focus on
damage control tactics in these locations, while others focus
specifically on penetrating trauma and complications of trauma.
At least three of the chapters focus on major vascular injury and
how hemorrhage control in these specific locations can be
accomplished. It is no surprise that a correct answer on board
examinations when asked where to look for undiscovered blood
vii
viii Foreword
loss in a hypotensive trauma patient with no obvious source of
bleeding is the abdomen.
Every teacher of the surgical art takes his or her opportunity
to provide venues for surgical learning very seriously. Lifelong
learning by the surgeon is accomplished by continuing experi-
ence, continuing medical education at conferences, and reading
surgical journals and textbooks. The craft of trauma, critical
care and acute care surgery is among the most rapidly changing
areas of medicine, and requires the craftsman (surgeon) to be
more diligent in maintaining a current knowledge base of the
subject. This textbook is one means of accomplishing such a
lifelong mission.
The surgeon who becomes the “Go To” person for the sickest
of the sick, the most broken of the injured, and the most chal-
lenging of medical problems is in an envied position. Every
community has such a “Go-To” physician, and it is most often a
general (emergency acute care, trauma) surgeon. This person is
a “Top knife”, able to meet the most difficult of challenges. That
person, with a special genome and fine-honed skills, is a unique
individual, who continues to be challenged to understand and
master and apply the new and emerging skill sets.
Advanced and ever-evolving technology is aiding the sur-
geon in hemorrhage control and vascular reconstruction. The
trauma surgeon focusing on truncal injury and a master at hem-
orrhage control becomes the “gatekeeper” for any vascular
specialist who co-manages such patients. Preferably, the emer-
gency acute care trauma surgeon becomes an expert at endovas-
cular access and control. Such hybrid skills are essential for the
new-generation surgeon.
Kenneth L. Mattox, MD
Distinguished Service Professor
Baylor College of Medicine
Houston, TX
Foreword
It is my great pleasure and honour to write a foreword for this
Trauma Surgery manual, resulting from a worldwide coopera-
tion joining together most of the current best experts in trauma
surgery.
My surgical experience began almost half century ago, start-
ing initially with general abdominal and thoracic surgery, with
a particular focus on liver surgery. (I remember with pleasure
the fellowship I have done in Hanoi working together with the
amazing Ton Than Tung in the 1980s, and I cannot forget
the experience had at the famous Trauma Center of Baltimore).
In the last 20 years of my surgical career, I have been dedi-
cated exclusively to the surgery of trauma, being the chief of the
Emergency and Trauma Surgery Department of Maggiore
Hospital Regional Trauma Center, the first specialized trauma
center which has been established and recognized by the govern-
ment in Italy. Throughout the years the approach for manage-
ment of trauma patients changed significantly, following the
spreading of new concepts such as the philosophy of damage
control surgery, the predominance of non-operative management
for parenchymal injuries, and last but not least the tremendous
advances of interventional radiology techniques.
I would like to wholeheartedly thank all the authors and con-
tributors who helped in this ambitious project and congratulate
the Editors and acknowledge the hard and excellent work of
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