World Journal of Emergency Surgery最新文献

{"title":"Cumulative intra-abdominal pressure exposure and dynamic trajectories in ICU-admitted patients reveal prognostic determinants of severe acute pancreatitis","authors":"Maobin Kuang, Yaoyu Zou, Shixuan Xiong, Cong He, Nianshuang Li, Ling Ding, Xueyang Li, Huijie Zhang, Yupeng Lei, Xin Huang, Huifang Xiong, Lingyu Luo, Liang Xia, Wenhua He, Nonghua Lv, Jianhua Wan, Yin Zhu","doi":"10.1186/s13017-025-00646-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00646-y","url":null,"abstract":"Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP. This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005–2023) and 83 from MIMIC-IV (2008–2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose–response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP’s role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was employed to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed. Over a median inpatient follow-up of 17 days in the Jiangxi cohort, 200 (19.8%) patients died in hospital, while 208 (20.6%) and 329 (32.6%) developed IPN and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of adverse clinical outcomes. This is the first study to revealed that CumIAP is linearly positively correlated with death and PMOF, while exhibits a U-shaped relationship with IPN. Notably, patients with low baseline IAP and a rising trajectory exhibited worse outcomes than those with high baseline IAP and a declining trend. This is the first study to introduce CumIAP as a quantitative metric to assess the early IAP burden and its prognostic significance in SAP, overcoming the limitations of static IAP monitoring. RCS and regression analyses revealed a positive linear association between CumIAP and in hospital mortality/PMOF, and a U-shaped relationship with IPN, suggesting the possible presence of a risk threshold. LCGMM identified three IAP trajectory patterns; the \"low baseline with rising trend\" group (LPI-T3) had the worst outcomes, underscoring the value of dynamic over static IAP monitoring. Mediation analysis showed that CumIAP partly mediated the effects of hypoalbuminemia and ANC on o","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"23 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025","authors":"Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui","doi":"10.1186/s13017-025-00648-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00648-w","url":null,"abstract":"Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life after emergency abdominal surgery","authors":"Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova","doi":"10.1186/s13017-025-00643-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00643-1","url":null,"abstract":"Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High platelet-to-red blood cell ratio and outcomes in trauma patients requiring massive transfusions","authors":"Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu","doi":"10.1186/s13017-025-00645-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00645-z","url":null,"abstract":"Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"29 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation and accuracy of intra-abdominal pressure measurement in different body positions: a prospective study","authors":"Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain","doi":"10.1186/s13017-025-00644-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00644-0","url":null,"abstract":"Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"15 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The synchronized pager explosions: an unprecedented pattern of injuries.","authors":"Alameddine Ramzi, Noureddin Baha', Mansour Ahmad, Joanna Saade, Wajiha Jurdi Kheir","doi":"10.1186/s13017-025-00587-6","DOIUrl":"10.1186/s13017-025-00587-6","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":"70"},"PeriodicalIF":5.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of infected pancreatic necrosis in patients with acute necrotizing pancreatitis based on ensemble machine learning model.","authors":"Zefang Sun,Yan Fu,Jiarong Li,Baiqi Liu,Xiaoyue Hong,Chiayen Lin,Dingcheng Shen,Caihong Ning,Lu Chen,Xiaoping Yi,Gengwen Huang","doi":"10.1186/s13017-025-00642-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00642-2","url":null,"abstract":"BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":"69"},"PeriodicalIF":8.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries","authors":"Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang","doi":"10.1186/s13017-025-00638-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00638-y","url":null,"abstract":"<p><b>Correction: World Journal of Emergency Surgery (2025) 20:19</b></p><p><b>https://doi.org/10.1186/s13017-025-00593-8</b></p><p>In this article [1], Mengdi Jin was mistakenly listed as a co-first author.</p><p>The original article has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><span>Author notes</span><ol><li><p>Liuquan Mou and Haideng Song are co-first authors.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China</p><p>Liuquan Mu, Kaige Li, Yushan Guo &amp; Nan Jiang</p></li><li><p>Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China</p><p>Liuquan Mu</p></li><li><p>Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China</p><p>Haideng Song &amp; Mengdi Jin</p></li></ol><span>Authors</span><ol><li><span>Liuquan Mu</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Haideng Song</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Mengdi Jin</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Kaige Li</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yushan Guo</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Nan Jiang</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Corresponding author</h3><p>Correspondence to Nan Jiang.</p><h3>Publisher’s note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"96 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple skip incision skin-sparing debridement for perianal necrotizing fasciitis: a retrospective study","authors":"Qing Long, Chaochi Yue, Bin He, Jun Li","doi":"10.1186/s13017-025-00640-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00640-4","url":null,"abstract":"Multiple skip incision skin-sparing debridement (MSISSD) is a surgical procedure that excises infected tissue to achieve source control while retaining the infected but viable skin, thus overcoming some limitations of traditional surgical debridement. We aimed to introduce this skin-sparing debridement technique for the treatment of perianal necrotizing fasciitis (PNF) and retrospectively analyze its efficacy and safety. Patients with PNF who received MSISSD between January 2021 and August 2024 were included in this retrospective analysis. We investigated the patient characteristics (sex, age, disease duration, and LRINEC score) and clinical data (comorbid diseases, length of stay in the intensive care unit [ICU LOS], microbiological culture results, number of debridements, length of stay [LOS], wound healing time, treatment outcomes, and follow-up status). Twenty-two patients with PNF were enrolled, including 19 males (86%) and three females (14%). The median age, disease duration, and LRINEC score was 59.5 years (range: 26–77), 4.5 days (range: 2–10), and 4 (range: 1–10), respectively, and five cases had a LRINEC score ≥ 6 (23%). Among the 22 patients included, the most common comorbid disease was diabetes, with nine cases (41%). Nine (41%) patients were admitted to the ICU, with a median ICU LOS of 2 days. Of the patients with positive wound cultures (14, 64%), polymicrobial infections were identified in 3 (21%) and monomicrobial infections in 11 (79%). The most commonly isolated microorganisms were Escherichia coli (8, 57%) and Klebsiella pneumoniae (5, 36%). One patient underwent debridement twice, while the remaining patients underwent debridement once. The median LOS was 18 days, and the wound healing time was 61 days. No patient underwent reconstruction surgery. During the median follow-up period of 11 months, one patient developed anal fistula 6 months after surgery and recovered after undergoing anal fistula resection. No patient experienced recurrence of PNF or anal incontinence. MSISSD appears to be a promising and effective method for skin protection debridement, which can effectively protect the skin while ensuring adequate drainage, and rarely causing severe anal dysfunction.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored Negative Pressure Wound Therapy with instillation in diabetic, hypertensive, and obese patients-when guideline treatment is not enough: a case series and a proposal for the ANSWER score","authors":"Orestis Ioannidis, Elissavet Anestiadou, Konstantinos Zapsalis, Konstantinos Siozos, Ourania Kerasidou, Savvas Symeonidis, Stefanos Bitsianis, Manousos-Georgios Pramateftakis, Efstathios Kotidis, Ioannis Mantzoros, Konstantinos Angelopoulos, Barbara Driagka, Angeliki Cheva, Stamatios Angelopoulos","doi":"10.1186/s13017-025-00605-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00605-7","url":null,"abstract":"Wound healing is challenging in cases of impaired microcirculation, leading to wound chronicity, decreased quality of life, and increased morbidity. Surgical site infections (SSIs) pose a significant challenge in diabetic, hypertensive, and obese patients due to impaired microcirculation. Negative pressure wound therapy (NPWT) is a widely used adjunct in wound management, but its optimal parameters in this subgroup remain uncertain. Tailored management is essential, taking into consideration tissue perfusion status and the potential benefit of novel strategies for tissue healing. We report a case seires of three obese patients with diabetes mellitus type 2 and arterial hypertension who developed severe SSIs after abdominal surgery, with extended flap mobilization and were managed with tailored NPWT strategies, including lower negative pressures, NPWT with instillation and dwell time (NPWTi-d), reticulated open cell foam dressings with through holes (ROCF-CC), and ultrasonic-assisted wound debridement (UAW). Based on these cases, we propose the ANSWER score (tAilored Negative presSure Wound thErapy in micRoangiopathy) to optimize NPWT pressure settings. In Patient 1, NPWT using silver dressings was initiated at a continuous pressure of -125 mmHg, but after extended necrosis developed, the negative pressure was reduced to -50 mmHg. In Patients 2 and 3, a continuous NPWT was set at -50 mmHg, which is the lower value of the available negative pressure range for the system used, resulting in significantly fewer necrotic areas. Dressings were changed every 48–72 h and culture-directed antibiotics were administered to all patients. Our findings suggest that the use of NPWT remains a basic element in promoting acute and chronic wound healing. Innovative techniques such as NPWTi-d, ROCF-CC, and UAW debridement, combined with low negative pressure levels, may achieve optimal results in patients with microangiopathy. Microcirculation plays a crucial role in wound healing, since impaired healing and a low rate of tissue regeneration have been observed in patients with compromised tissue perfusion, such as patients with diabetes, obesity, or arterial hypertension. However, the use of NPWT in patients with microangiopathy and extensive tissue dissection at the default operating pressure of -125 mmHg may lead to further ischemic necrosis. Based on our case series, a clinical score (ANSWER score- tAilored Negative presSure Wound thErapy in micRoangiopathy) is proposed as a useful tool that reflects the ideal level of negative pressure for patients with impaired microcirculation. The ANSWER score assigns risk factors (obesity, arterial hypertension, diabetes) a point each, reducing NPWT pressure accordingly (-25 mmHg per point from − 125 mmHg). Tailored NPWT settings, based on the ANSWER score, may enhance wound healing outcomes in patients with microangiopathy. Further clinical studies are warranted to validate this approach.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}