Trauma Surgery & Acute Care Open最新文献

{"title":"Access, equity, and innovation in the management of the open abdomen: the lack of proper treatment and the impact in low-income populations.","authors":"Marcelo Augusto Fontenelle Ribeiro","doi":"10.1136/tsaco-2025-001945","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001945","url":null,"abstract":"<p><p>The open abdomen (OA) has evolved from a wartime necessity into a core component of damage control surgery and of the management of complex abdominal disease, and now also encompasses abdominal compartment syndrome and severe gastrointestinal complications. Negative pressure therapy (NPT) and, more recently, fascial traction adjuncts have transformed outcomes in high-income settings, but access remains profoundly unequal, and that inequality translates into morbidity and mortality driven not by disease severity, but by the inability to meet a minimum standard of care. That inequality is now measurable. In the International Register of Open Abdomen, definitive abdominal closure was achieved in 82.3% of patients in the Americas against 56.4% in Asia, with mortality of 31.9%, 51.6% and 56.9% in the American, European, and Asian continents, and commercial NPT used in 77.4% of American patients against a Barker vacuum pack in 48.2% of Asian patients. This article proposes an agenda for closing that gap. It reviews temporary abdominal closure from the Borraez (Bogota) bag and the Barker vacuum pack to commercial NPT, and the fascial traction adjuncts that most strongly analyze primary fascial closure, pairing each with its approximate cost and feasibility in a resource-constrained hospital. Four proposals follow: a resource-stratified standard of care defining a minimum acceptable package at three tiers of institutional capability; a formal evaluation program for locally assembled, low-cost negative pressure systems applied to the laparostomy; prioritization of fascial traction, the cheapest and most transferable element of contemporary care, as the first upgrade where commercial NPT is unaffordable; and an industry, regulatory, and society agenda covering serviceable reusable devices, tiered pricing, essential-device listing, and a registry reaching beyond the academic centers now contributing data. Closing this gap is an engineering, regulatory, and research problem as much as a clinical one, and it is solvable.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001945"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting ahead of violence: a community-based primary prevention approach led by medical students.","authors":"Hanae Fujii, Leticia M Ryan","doi":"10.1136/tsaco-2026-002555","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002555","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002555"},"PeriodicalIF":2.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: \"It is nice, but it can't keep me safe\": perspectives on the effectiveness of hospital-based violence intervention programs.","authors":"Joseph A Kern, Rodney Babb, Elinore J Kaufman","doi":"10.1136/tsaco-2026-002562","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002562","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002562"},"PeriodicalIF":2.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are surgical critical care fellows doing after graduation? A report from the Surgical Critical Care Program Director Society Outcomes Task Force.","authors":"Emily Renee Faulks, Ahmed N Al Qaffas, Linda Dultz, Laura N Haines, Stefan Leichtle, Krista L Kaups, Joshua Aaron Marks, Kazuhide Matsushima, Robert Maxwell, Charles A Adams","doi":"10.1136/tsaco-2025-001967","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001967","url":null,"abstract":"<p><strong>Background: </strong>Surgical Critical Care (SCC) training includes 1-year or 2-year fellowships. The second year is program dependent. No studies have evaluated SCC Fellowship outcomes from the graduate's perspective. The Surgical Critical Care Program Director Society (SCCPDS) conducted a survey for graduating SCC Fellows evaluating fellowship choice, ability to obtain a job, and overall satisfaction.</p><p><strong>Methods: </strong>Graduating SCC Fellows completed a survey regarding fellowship and hospital data, job data, and fellowship satisfaction.</p><p><strong>Results: </strong>There were 84 (83.2%) responses for fellowship and hospital data. Sixty-six (78.6%) completed 1-year fellowship, and 18 (21.4%) completed 2-year fellowship. Fifty-six (66.7%) desired a 1-year program, 17 (20.2%) desired a 2-year program, and 11 (13.1%) had no preference. All (100%) were satisfied with the length of their training.Fifty-seven (56.4%) responded regarding future jobs. Future areas of practice will include trauma (53, 93.0%), emergency general surgery (52, 91.2%), and surgical critical care (57, 100.0%). Additional areas include medical critical care (4, 7.0%), neurocritical care (6, 10.5%), cardiothoracic critical care (4, 7.0%), extracorporeal membrane oxygenation (4, 7.0%), burns (9, 15.8%), and elective general surgery (30, 52.6%).Seventy-four (73.3%) discussed fellowship satisfaction. Most believed that fellowship prepared them well for future careers, with 58 (78.4%) strongly agreeing and 10 (13.5%) agreeing. Nearly 80% of fellows agreed or strongly agreed (40, 54.1% and 19, 25.7%) that they were able to obtain the job of their choice.There was no statistically significant association of a second year of training and obtaining the job of their choosing. Fellows were able to get their job of choice regardless of fellowship satisfaction and the 2-year fellowship requirement for some places of employment. There was no association between fellowship or job locations.</p><p><strong>Conclusion: </strong>Most fellows were satisfied with fellowship length and content choices. Fellows overall obtained their job of choice. Our study confirms that continued diversity of SCC Fellowship types is important.Level of evidenceLevel of evidence is Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e001967"},"PeriodicalIF":2.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major liver necrosis after blunt trauma.","authors":"Caitlyn Braschi, Eric J Ley, Alisa Cross, Stacy Dougherty-Welch, Kazuhide Matsushima","doi":"10.1136/tsaco-2026-002453","DOIUrl":"10.1136/tsaco-2026-002453","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002453"},"PeriodicalIF":2.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Devastating ballistic trauma complicated by necrotizing soft tissue infection.","authors":"Tullis Tien-Tze Liu, Kefan Cui, Kevin Urlaub, Matthew Skalak, Andrew M Wishy, Saif Badran, Lindsay M Kranker","doi":"10.1136/tsaco-2026-002400","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002400","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002400"},"PeriodicalIF":2.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute cholecystitis in high-risk patients: a systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).","authors":"Asanthi Ratnasekera, Rishi Rattan, Bishwajit Bhattacharya, Zugui Zhang, Madison Harris, Sirivan S Seng, Connor Magura, Christopher A Butts, Judy Rabinowitz, Jordan Michael Kirsch, Ida Molavi, Haytham Kaafarani, Tejal S Brahmbhatt, Michael W Cripps, Nikolay Bugaev, John J Como","doi":"10.1136/tsaco-2025-002191","DOIUrl":"10.1136/tsaco-2025-002191","url":null,"abstract":"<p><strong>Background: </strong>High-risk patients with acute calculous cholecystitis (ACC) require an individualized approach and may not be eligible for cholecystectomy. The aim of this systematic review was to evaluate the management of ACC in patients with either high operative risk or delayed presentation.</p><p><strong>Methods: </strong>An evidence-based systematic review was performed to answer the Population, Intervention, Comparator, Outcomes (PICO) questions. This systematic review was registered with PROSPERO (CRD42024610156). An academic health science librarian and lead authors developed the search strategy. The search was conducted in Medline (Ovid), Embase (Elsevier), Cochrane CENTRAL (Ovid), and Web of Science. The search strategy was written for Medline and translated using each database's syntax, subject headings, and search fields. An initial search, conducted on August 3, 2020, was updated on June 5, 2025.</p><p><strong>Results: </strong>A total of 25 studies were identified. We conditionally recommend that high-risk patients with ACC undergo treatment with antibiotics alone versus using percutaneous cholecystostomy (PC) and antibiotics. No recommendation was made to treat patients with ACC with more than 5 days of symptoms with either cholecystectomy or antibiotics. No recommendation was made to treat patients with ACC with more than 5 days of symptoms with PC or antibiotics. We conditionally recommend removing the PC catheter without performing cholecystectomy after resolution of ACC in high-risk patients who have evidence of cystic duct patency.</p><p><strong>Conclusion: </strong>Risks of cholecystectomy and PC must be balanced in patients who are high-risk for operative management.</p><p><strong>Level of evidence: </strong>Level III, systematic review and meta-analysis.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002191"},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From alphabets to action: considering next steps in 'circulation-first' management.","authors":"Alexandra Mp Brito, James E Kenny","doi":"10.1136/tsaco-2026-002547","DOIUrl":"10.1136/tsaco-2026-002547","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002547"},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"War surgeon's Cap.","authors":"Alexander Malloy","doi":"10.1136/tsaco-2026-002544","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002544","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002544"},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfixing trauma: management of a rare fence post impalement injury.","authors":"Claudia Satzke, John Hallmark, Mike Mallah, Ashley Hink","doi":"10.1136/tsaco-2026-002309","DOIUrl":"10.1136/tsaco-2026-002309","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002309"},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}