(no subject)

[Timothy Craig Hardcastle]

Mike

At a first Damage Control procedure I would NOT be doing a pyloric
exclusion. At relook about 48hrs post DC1, I would review my anastomosis
- if it is Ok I would leave well alone. If there was any doubtful
viability I would debride and redo it. I always leave a drain for the
duodenal repairs, but really only use the Vaughn type repair for
difficult part 2's (very selectively).

Having said all the above - if the patient was unstable with the need
for a massive T/F I would have stapled off the ends and repaired it only
at DC3 procedure (i.e. at 48 hours).

Most of the time, a stable patient just gets a primary repair, no matter
where in the duodenum. Since I work in a penetrating trauma rich,
resource-poor country we learn to do the "less is more" concept.

My 2c

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: 19 May 2008 01:45
To: trauma-list at trauma.org
Subject: (no subject)

Duodenal injuries - when to interrupt the pylorus and how to do it.
 
Difficult duodenal repair for injury to the 4th portion not involving
the pancreas and remote to the ampulla. Through and through 45 caliber
gunshot wound suture closure but concern for the repair. Vena cava also
repaired. 12 units of pRBCs, 12 of FFP and, a 12 pack of platelets.
Planning a temporary abdominal wall closure. Do you interrupt the
pylorus and, if so, how do you do it.
 
Mike Sise
San Diego

"Scripps Information Security" 
------------------------------------------------------------------------
------
This e-mail and any files transmitted with it may contain privileged and
confidential information and are intended solely for the use of the
individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the e-mail
to the intended recipient, you are hereby notified that any
dissemination or copying of this e-mail or any of its attachment(s) is
strictly prohibited. If you have received this e-mail in error, please
immediately notify the sending individual or entity by e-mail and
permanently delete the original e-mail and attachment(s) from your
computer system. Thank you for your cooperation.


========================================================================
======
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/