A. Hirshberg et al., PLANNED REOPERATION FOR TRAUMA - A 2-YEAR EXPERIENCE WITH 124 CONSECUTIVE PATIENTS, The journal of trauma, injury, infection, and critical care, 37(3), 1994, pp. 365-369
Planned reoperation is a new approach to severe truncal trauma. A revi
ew of 124 patients treated over two years was undertaken. Penetrating
injuries predominated (78%) involving primarily the abdomen or abdomen
and chest. An abbreviated procedure was performed when direct hemosta
sis was impossible (102 patients), abrupt termination was required (56
patients), or the abdomen or chest could not be closed (20 patients).
The techniques employed included packing, rapid skin closure, gastroi
ntestinal interruption, rapid vascular control, temporary urinary dive
rsion, stapled lung resection, and plastic bag closure. Seventy-three
patients survived to undergo 101 operations. The first reoperation was
planned in 52 patients and unplanned (either for bleeding or for abdo
minal compartment syndrome) in 21 patients. There were 14 missed injur
ies. The overall mortality rate was 58%. Survival was significantly be
tter when the decision to abruptly terminate the initial procedure was
made early and in patients undergoing planned reoperation. Wider adop
tion and better definition of the indications will result in more effe
ctive use of this approach.