22nd European Congress of Trauma & Emergency Surgery

Chairs

Prof. Dr.

Dr. med.

Prof. Dr. med.

The association of injury distribution and physiologic response with decision making in polytrauma patients – Predicting treatment strategy and timing of surgery

Abstract text (incl. references and figure legends) Introduction Timing of fracture fixation in polytrauma patient is subject to major controversies. The goal of this study was to define variables that predict the treatment strategy in polytrauma patients. Methods Retrospective cohort study included polytrauma patients, ISS of 16 points and above, primary admission and requirement for the ICU. primary outcome was surgical treatment strategy: immediate definitive surgery (IDS, last osteosynthesis within 12 hours of admission), safe definitive surgery (SDS, first definitive osteosynthesis within 48 hours), and delayed definitive surgery (DDS, first definitive osteosynthesis after 48 hours of admission, or no surgical intervention). Variables of interest included in the prediction model were: injury severity (abbreviated injury scale, AIS), and pathophysiologic parameters at admission of the four vicious cycles (hemorrhagic shock, coagulopathy, hypothermia, and soft tissue trauma). Results Out of 813 patients, 48 (5.9%) had IDS, 362 (44.5%) SDS, and 403 (49.6%) DDS. The mean age of patients was 55.4 (SD 20.5) years, mean injury severity score (ISS) was 23.0 (SD 11.5) points, and overall mortality was 27.3%. Increased AIS spine was associated with IDS (OR 1.8, 95%CI 1.2 to 2.7, p &lt; 0.001); increased AIS of the extremity was associated with SDS (upper extremity: OR 2.3, 95%CI 1.5 to 3.4, p &lt; 0.001, lower extremity: 1.4, 95%CI 1.1 to 1.8, p = 0.002); increased AIS head was associated with DDS (OR 1.4, 95%CI 1.3 to 1.6). The prediction of SDS was highest when all physiologic parameters including hemorrhagic shock, temperature, coagulation, and soft tissue were taken into consideration (AUC 0.8, 95%CI 0.7 to 0.9). Conclusion SDS is a frequently used surgical treatment straty in resuscitated polytrauma patients. The treating trauma surgeon bases the decision for treatment strategy on injury distribution, local and systemic injury severity, and on the pathophysiologic response after trauma.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) None

Polytrauma

Poster

Prof.

Looking for the best benchmark to avoid unnecessary massive transfusion protocol activation: A pilot cluster analysis from a Level-1 trauma center

Abstract text (incl. references and figure legends) Introduction: Massive transfusion protocols (MTP) are used in bleeding trauma patients (TP) undergoing damage control strategies to control critical hemorrhages (CH). CH is defined as the need for at least four red blood cells (RBC) within an hour. Current tools (shock index[SI], TASH, and ABC score) to predict the risk of MTP activation have good accuracy but are not helpful to identify early TP in which the MTP should be effectively continued. The focus of the study is to identify specific features of TP in which MTP was activated but not continued. Material and Methods: We included TP with MTP activation from May 2020 to October 2021 treated at Niguarda Trauma Center. We performed a pilot cluster analysis of TP considering MTP risk prediction tools with the Kamila method. We then made a group comparison between clusters to look for differences in terms of clinical features, Arterial Blood Gas analysis parameters and blood products transfused. Results: Fifty-six TP were included in the analysis. Three clusters (C1, C2, C3) were identified. C1 and C2 included patients with the lowest and highest use of RBC in the first six hours (C1 3,8 vs C2 16 vs C3 8,8) and Injury Severity Score (C1 29,1 vs C2 43,7 vs C3 37,5). C2 patients had the worst arterial blood gas parameters and underwent more damage control procedures, especially compared to C1. The mortality rate was not different at any time of trauma management. Conclusion: In this pilot study, we identified a cluster in which MTP was not continued, therefore probably not needed for resuscitation, with specific features. Further multi-institutional studies on larger samples should focus on tools to early identify TP who really need MTP to avoid inappropriate activation and optimize resource allocation. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Visceral trauma

How the SARS-COV-2 pandemic change the polytrauma paradigm: A sociodemographic and clinical analysis

Abstract text (incl. references and figure legends) Introduction Due to the pandemic caused by SARS-cov-2 infection of 2020 and the consequent lockdown,a decrease in global work and social activity was observed.We analyze how this situation caused a reduce in trauma patients and a change in their mechanisms and modes of injury Material and methods Retrospective analysis of differences between patients treated for severe polytrauma in 2019 (pre-pandemic) and 2020 (pandemic).Variables analysed:age, sex, mechanism and mode of injury,injury severity score(ISS),need for urgent surgery and mortality Results In 2019, 64 polytraumatized patients were admitted compared to 44 in 2020.The average age in 2019:38.5(17-84) and in 2020:43(15-76). According to sex: 2019:78.1% men,21.9% women and 2020:72.7% men and 27.3% women The average ISS in 2019 is 23(5-66) and in 2020 is 26.6(5-57).The mortality is 6.3%(4) in 2019 and 7.5%(3) in 2020 We resume mechanism of lesion and type injury in the graphics below Conclusions A clear decrease in admissions is observed comparing 2019 and 2020 (64 to 44).A change in the mode and mechanism of injury is confirmed,with a clear decrease in traffic accidents(46.9% to 31.8%),surely due to mobility limitations and an increase in precipitation and suicide attempts(10.9% to 25%) secondary to the breakdown of social networks and limited access to mental health consultations References -Impact of lockdown during the COVID-19 pandemic on number of patients and patterns of injuries at a level I trauma center.Arastoo Nia ,Domenik Popp ,Cornelia Diendorfer ,Sebastian Apprich ,Alexandru Munteanu ,Stefan Hajdu ,Harald K Widhalm .Wien Klin Wochenschr.2021 Apr;133(7-8):336-343 -Impact of societal restrictions and lockdown on trauma admissions during the COVID-19 pandemic:a single-centre cross-sectional observational study.Susan Jacob ,Derek Mwagiru ,Ishaan Thakur ,Alireza Moghadam ,Thomas Oh ,Jeremy Hsu. ANZ J Surg.2020 Nov;90(11):2227-2231Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

The use of computed tomography (CT) in hemodynamically unstable polytrauma: A paradigm shift.

Abstract text (incl. references and figure legends) Introduction Most present guidelines contraindicate performing CT scan in ustable polytrauma patient and determine direct transfer to the operating room (OR). Recently, CT scan has been considered as first evaluation, regardless of hemodynamic stability. Material and methods We identified all severe polytrauma patients evaluated at our institution between 01/01/2019 and 31/12/2020. We defined hemodynamically unstable patients as those who required vasoactive drugs (VSA) in the primary evaluation. We analyzed the following variables: age, sex, focused assessment with Sonography for Trauma (FAST), CT scan before or after surgery, need of surgical intervention, complications, intensive care unit (ICU), length of stay and acute-phase mortality. Results Of the 108 patients evaluated in the study period, 31 required VSA and were included for the analysis. 35,5% were women and 64,5% men. 80,6% of the VSA group underwent FAST, with positive results in 45,2%. A CT scan was performed in 93,5%: 72,4% before surgery and only 27,6% after surgery. Global mortality was 20,7%: 14,3% were in cases with CT scan before surgery, and 37,5% in cases with CT after surgery, not being statistically significant (Image 1 and 2). No statistically significant differences were obtained between CT scan before or after surgery regarding ICU length of stay, complications, OR time and mortality. Conclusions A new paradigm is opened on the use of CT body in hemodynamically unstable patients. In our study the mortality was higher in patients where the CT scan was done after surgery. However no statistically significant differences were found, may be related to a small sample, so we will carry out further studies to be able to study this new paradigm. References Huber-Wagner, Stefana; Kanz, Karl-Georga et al. Whole-body computed tomography in severely injured patients. Current Opinion in Critical Care: February 2018 - Volume 24 - Issue 1 p 55-61. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Emergency surgery

Open fracture of the sacrum in a fall from a fifth floor

Abstract text (incl. references and figure legends) Case history A 17-year-old male with open sacral fracture due to precipitation from a fifth floor. Clinical findings On examination, the patient presented an open wound with a sacral fracture and significant loss of substance. Investigation/Results CT scan showed L2 vertebral body fracture with retropulsion of the posterior wall, complex fracture of the sacrum with a posterior displacement of 4 cm and bone exposure throught skin defect later and large retroperitoneal hematoma. Diagnosis Complex fracture of the sacrum Gustilo IIIC. Therapy and progressions Orthopedic and General surgeons intervened for unloading colostomy and peritoneal packing with Friedrich of the sacral wound. Repeated surgical washes were required in the following days until definitive surgery, which involved a sacral plate and subsequent spinopelvic fixation L1-L5. Subsequent coverage was performed with a gluteal rotation flap. The patient suffered from several surgical site infections during his admission, for which it was required antibiotic therapy. He was later discharged to a paraplegic center. Al the present time, he has currently regained full strength in his hips and knees, although paresis of his ankles and feet persists and it is pending the performance of a self-catheterization due to sphincter alteration. Comments The main cause of sacral fractures in young people is high-energy trauma and it may be associated with neurological deficits. Open fractures are a challenge due to the possibiliy of infection and the complexity of coverage. In caso co concomitance with a lumbar fracture, it is recommended the association of spinopelvis fixation and posterior tension band plating. References Rodrigues-Pinto R, Kurd MF, Schroeder GD, Kepler CK, Krieg JC, Holstein JH, Bellabarba C, Firoozabadi R, Oner FC, Kandziora F, Dvorak MF, Kleweno CP, Vialle LR, Rajasekaran S, Schanke KJ, Vaccaro AR. Sacral fractures and associated injuries. Global Spine J. 2017 Oct;7(7):609-616.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

Skeletal trauma and sports medicine

A case of successful limb salvage of thigh compartment syndrome and recurrent infections secondary to traumatic external iliac artery injury

Abstract text (incl. references and figure legends) A 19 year-old male was involved in a unwitnessed motorcycle accident and found lying on the road. He arrived at the emergency department of our hospital. He was hemodynamically unstable. We could not confirm his active movement of the lower legs. The pelvic ring was clinically unstable. The left thigh was deformed and there were signs of ischemia on the left lower limb. The plain radiographs on admission revealed the bilateral pubic rami fractures, the sacral fractures, and the left femoral shaft fracture. Enhanced computed tomography showed occlusion of the left external iliac artery. Left external iliac artery occlusion, unstable pelvic ring fractures, and left femoral shaft fracture. The patient was admitted to the operating room. The arterial bypass procedure from the base of the external iliac artery to the femoral artery using an artificial vessel was performed. Ischemia time was about 6 hours. The pelvic ring fractures and the femoral shaft fracture were provisionally stabilized with external fixators. He developed the thigh compartment syndrome and fasciotomy of the thigh was applied 3 days after injury. Definitive fixations of the left femur and the pelvis were performed 6 days after injury. Necrotic muscle tissue of the anterior thigh was surgically debrided 10 days after injury. The defect at the left thigh was covered with the free flap which resulted in failure because of infection. Surgical debridement of the thigh had been repeated. The open wound managed to be closed completely 195 days after injury. On the final follow up at two years after injury, he can ambulate with a wheel chair and he was satisfied with the limb salvage though his left lower limb remained completely paralyzed. Early skeletal stabilizations and persistent multiple debridement of necrotic and infectious tissue were the keys to success for the limb salvage after the external iliac artery injury. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Peroneal palsy in polytraumatised patient – Case study

Abstract text (incl. references and figure legends) Case history A 24-year-old female was hit by a car. The patient was brought to our emergency department by an ambulance vehicle. Clinical findings The pacient was conscious and could communicate with normal vital signs. After the primary survey the patient was declared stable. Investigation/Results/Diagnosis: The CT scan showed minor pneumothorax and the X rays showed humeral shaft fracture on the left humerus, platotibial fracture on the right side, bimalleolar ankle fracture of the right ankle and fracture of the proximal left fibula [2]. Therapy and progressions Two days after admition in the ICU, an ORIF was performed .Two days later, CT scan of the chest and abdomen with IV contrast was perforemed and it showed pleural effusion with partial atelectasis on the left lung.The next days in the ICU went well and the patient was sent to the hospital depatment at the University clinic of Traumatology.Three days later was discharged. On the day of check up the immobilisation was removed and she could not make a dorsal flexion of the left foot. She was told to obtain a neurology and neurosurgeon consult. Two monts later she underwent adhesiolosis and transposition surgery of the peroneal nerve and was sent to physical therapy. Comments The involvement of the peroneal nerve is mainly caused by the compression or traction of the nerve[3]. Prognosis depends primarily on the severity of the initial nerve injury[1]. References 1. Popa et al., Medical management and rehabilitation in posttraumatic common peroneal nerve palsy,Balneo and PRM Research Journal 2022, 13(1): 496 2. Lezak B, Massel DH,Varacallo M. Peroneal Nerve Injury.[Updated 2022 May 8]. In: StatPearls [Internet].Treasure Island (FL) 3. Common peroneal nerve palsy with fibula head fracture: Case report Kazuaki Sonofuchi, Shingo Nobuta, Taku Hatta, Katsumi Sato, Eiji Itoi-Tohoku University School of Medicine, Sendai, Japan 4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peroneal-nerve-injuryDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Reducing delays in care for polytrauma patients with non life-threatening injuries by the use of an ambulatory team for Optimized treatment of Multitrauma-patients (ATOM)

Abstract text (incl. references and figure legends) Introduction: Polytrauma patients need involvement of various specialists and professionals. Uncoordinated involvement of these professionals may lead to delayed diagnostics and treatment of non-life-threatening injuries. We hypothesized that improved coordination would prevent delays. Method: Patients with Injury Severity Score (ISS) ≥ 8 affecting &gt;1 body region were included, patients with severe burns and patients who died within 30 days were excluded. Data was retrieved from the local trauma registry. A quality improvement (QI) project was established with an ambulatory team (ATOM) - a trauma surgeon, a rehabilitation physician and a coordinating trauma nurse. Patients were visited twice weekly during ATOM rounds, with the aim to note unresolved issues and discuss any concerns with ward personnel, as well as with the patient. A tertiary survey was performed on all patients within 24 hours of admittance, to look for undetected injuries. Patient reported experience measures (PREMs) were offered to all patients ≥ 18 years old as a survey on an iPad. Complications were registered in the local trauma register. Results: The share of patients visited twice weekly by the ATOM and who were examined with a tertiary survey, increased to nearly 100 % and stabilized. For the subgroup of patients who were hospitalized for 4–16 days, there was a 25 % increase in ISS. There was no significant change in Length of stay (LOS), but the variation in LOS was reduced. Discussion: Patients discharged by day 16 had on average more serious injuries than prior to the start of the project, indicating that the project lead to more time-efficient treatment of severely injured patients, probably due to better coordination of involved specialists.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Education

Pelvic trauma and ovarian teratoma ropture secondary to road accident

Abstract text (incl. references and figure legends) CASE HYSTORYWe present a case of a 17 years old female victims of road accident, pedestrian run over. The prehospital evaluation report: head rauma, chest trauma with pleural effusion, suspicious free fluid abdomen. INVESTIGATION/RESOULTSIn hospital the CT scan demonstarted freefluid with high density in abdomen with a sosuspicious of gynecological lesion. Ilo-ischio, sacral fins and limb fracture,without nerve and vessel lesions.Gynecologycal US evaluation confirmed bleeding.DIAGNOSISropture of large right ovarian,Right limb frature,right ileoischiopubic fracture and sacral fins fracture no vessel and nerve lesionTHERAPY AND PROGRESSIONThe patients undergo to laparoscopy esploration with evidence of mixed free fluid and a ropture of large right ovarian teratoma,complete excision of the cyst, toelette e drainage of abdomen was performed.Stabilization with medulalry nail for the frature of the limb was performed by ortohpedic surgeon.NOM for pelvic and sacral Fracture.The postoperative outcome was without organic complication, removal of dreinage in III POD, starting of FKT during the recovery and discharged at home for the continuation of fkt and outpatients control. The patient has experienced post-traumatic stress disorder with taking charges by psycological hospital service COMMENTSMajor trauma patients experience a 20% mortality rate overall, and many survivors remain permanently disabled. Survival after major trauma is considered to be time dependent. Severe injuries rapresent a considerable public health burden, with significant personal and societal costs. In Italy, the estimated cost of trauma care accounts for about 7% of the overall public healthcare costs. REFERENCES 1.Non-operative management for abdominal solidorgan injuries: A literaturereviewA Kanlerd*&amp;A Chinese Journal of Traumatology 25 (2022) 249e256 2.Abominal trauma: from operative to nonoperativemanagementLLeenenInjury, Int. J. Care Injured (2009) 40S4, S62– S68Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Sudden cardiac arrest due to blunt cardiac injury during multiple trauma care: A case report

Abstract text (incl. references and figure legends) Case history: A 38 y.o. male was injured while he was driving a car and was administered the emergency room. He had no past medical history. Clinical findings: He was treated by ATLS approach. Airway was open, respiratory rate was 38/min, SpO2 94% (oxygen mask 10L), heart rate was 82 beats/min, blood pressure was 67/35 mmHg, focused assessment with sonography for trauma (FAST) was negative, x-ray showed pelvic fracture, external bleeding was controlled. Glasgow Coma Scale was E3V4M5, and without hypothermia. The ECG showed normal sinus rhythm and right bundle branch block. Investigation and diagnosis: After extracellular fluid and blood transfusion therapies, he was performed with CT images. Diagnosis: Bilateral rib and sternal fractures, liver injury, pelvic fracture, multiple fractures of the left lower leg. Therapy and Progressions: Tracheal intubation was performed. After the intubation, his heart rate was suddenly dropped and went into cardiac arrest. He repeated pulseless electrical activity and return of spontaneous circulation. After starting Isoprenaline, the pulse rate stabilized. Further investigation revealed the complete atrioventricular block, temporally pacemaker (tPM) was implanted in emergency. The troponin level was high at admission, suggesting blunt cardiac injury. Echocardiography showed wall motion was normal and ejection fraction was 65% without pericardiac effusion. tPM was removed after 3 days. In 124 days, he was discharged from the hospital with crutches, without neurological symptoms. Comments: Hemorrhage from injured extremities and arrhythmia by cardiac contusion led the severe hemodynamic instability. Previous reports showed difficulty in detecting blunt cardiac trauma in early phase in ER treatment. Careful assessment of arrythmia is crucial in cases of severe chest trauma. Reference: Azade,et al: Air Med J. 2021: Myocardial Contusion: A Case of Fatal Cardiac Dysrhythmias During Air Medical Transportation.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Liver through and through lesion due to a stab wound. Old haemostatic resources in the arteriography era

Abstract text (incl. references and figure legends) 16-year-old male patient who arrived at the emergency room after suffering penetrating abdominal trauma with a knife at hight school. He was assessed using the ATLS principles; A: Airway clear, C-Spine cleared clinically. B: Respiratory rate 15bpm. C: Hemodynamic instability. Blood pressure 90/60mmHg, heart rate 120bpm. D: E: Temperature 36.7ºC. 2cm stabwound at epigastrium. No other wounds were found. E-FAST: Positive in the abdomen. An emergent surgery was performed. By mid-line laparotomy, the abdominal cavity was exposed. All the blood and clots were removed, and the abdominal cavity was packed to stop the bleeding. Then, the abdominal cavity was explored sequentially. A through-and-through wound on the left liver (segments II-III) was adverted, not involving the cava vein. There was an active venous bleeding. No other haemorrhagic injuries were found. The bleeding stopped with compression but continued after removing the packing. It was hard to control due to the depth of the wound. We decide to use a balloon tamponade (Poggetti et al 1992). A urinary catheter was introduced inside a sterile glove finger and the open end was sealed using a silk suture. This device was inserted through the liver wound and the glove finger was inflated with saline solution. The balloon was left in place for 15 minutes, while we took a secondary look, in search for any intestinal injury. The pressure reduced the bleeding however not stop in completely. We then decide to use a haemostatic matrix based on thrombin solution to completely fill the wound. After the surgery, our patient was haemodynamically stabilized, and he was discharged 4 days after. The surgical management in liver traumatic injuries is difficult, and each time less frequent due to the extent of the arteriography. However, it is still sometimes necessary. With this case, we would like to highlight some of the different resources available.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Ass. Dr

Individualized patient-based strategies on early treatment of thoracolumbar fractures in polytrauma patients

Abstract text (incl. references and figure legends) The combination of polytrauma and spine injury is important due to the high incidence of complications and secondary neurological deterioration. The complex and not standardized approach of this group of injured patients with a wide spectrum of injuries makes it difficult to treat. DCO is a good strategy for the treatment of polytrauma patients but unfortunately is not often available for these patients with a thoracolumbar spine injury. By expanding the time limit; following the trend of occult peripheral hypoperfusion; specifically analyzing individually associated injuries, and individualizing the treatment "tailored" to each patient, according to the Safe Definitive Surgery Strategy, we have achieved better results in treating this group of pt. We have collected retrospectively and analyzed data from all polytrauma patients that involve thoracolumbar fractures from 2015 – 2020. 83 patients met the inclusion criteria of ISS&gt;15, age 16-70. Early intervention (&lt;48h) has been performed on 32 patients. The posterior transpedicular fixation, with or without laminectomy has been done in all patients. Anterior decompression and stabilization were used on several patients, after the resolution of associated injuries. The late intervention has been performed on the rest of the pt. We compared the mortality, neurological recovery, length of hospital stay, and length of ICU stay between the early and late intervention groups. The mean follow-up was 16 months. Mortality was lower in the Early intervention group (EIG). The Length of hospital stay and ICU stay is obviously shorter on the EIG. The pressure sores and respiratory support are also lower in the EIG. Early intervention is a safe and preferred treatment strategy for the treatment of polytraumatized patients with spine injuries. The patient-tailored treatment, considering all the factors of the personality of the injury, seems to be the best treatment strategy for this group of patients.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no confict of interest.

How to get away with cutting your neck: Successful management of a suicidal injury

Abstract text (incl. references and figure legends) Case history, clinical findings A 57-year-old man, with a psychiatric history of depression and paranoid personality disorder, is brought to the emergency department following a self-inflicted trauma of the neck with a blade. Investigation/Results Upon arrival at the emergency room, the patient had a patent airway, had no dyspnea or respiratory difficulty, was hemodynamically normal and without signs of poor peripheral perfusion. He was conscious, cooperative and oriented, without other associated injuries. Diagnosis The patient was observed by a trauma team, which documented a sharp wound in the right anterolateral-basal portion of the cervical region, without active hemorrhage, but reaching the deep planes. The patient was stabilized and proposed for emergent wound exploration and closure. Therapy and Progressions In the operating room, a deep cutting wound was observed at the cervical level IV, with 20 cm of length, partial section of the omohyoid muscle and total section of the right sternocleidomastoid muscle. Hemostasis and approximation of the perimysium of the omohyoid muscle and of the proximal and distal ends of the sternocleidomastoid is performed. The patient had no complications in the perioperative period and was discharged on the fourth postoperative day. Comments Suicidal cut throat injuries regularly encountered by surgeons are limited to superficial wounds and hesitation cuts. We hereby present a case of suicidal cut injury in a psychiatric patient with sternocleidomastoid muscle transection. Cut throat injuries to neck are challenging in terms of being surgical emergencies, varied presentations and requirement of an efficient team work. References Naqvi Sayyed EH, Sadik A, Beg MH, et al. Successful management of suicidal cut throat injury with internal jugular, tracheal and esophageal transection: A case report. Trauma Case Reports. 2018 Feb;13:30-34. DOI: 10.1016/j.tcr.2017.11.005. PMID: 29644295; PMCID: PMC5887116.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Not just a stab in the back – Initial evaluation and management of stab wounds

Abstract text (incl. references and figure legends) Case history, clinical findings A 28-year-old man, victim of unwitnessed aggression, is found in the prone position with multiple incisions in the dorsolumbar region, flanks and upper limbs and with an estimated blood loss of 2 liters. Investigation/Results He is admitted to the emergency room with a patent airway, eupneic, hemodynamically stable, tachycardic, GCS of 15, with decreased strength and sensitivity in the lower limbs.A bladed weapon was introduced in the dorsal region in a median position, with several other entry ports at the thoraco-dorsal level, right flank and left arm. Diagnosis Hemodynamic stabilization is performed. Thoracoabdominopelvic CT angiography reveals no apparent hemopneumothorax, hemopericardium or large-vessel involvement. No apparent pneumoperitoneum or free liquid. Liver and spleen without apparent lesions. A stab blade is observed at the level of the 8th dorsal vertebral body, with apparent medullary transection. Therapy and Progressions The patient is proposed for emergent stab removal with dural plasty, and for exploratory laparoscopy, which documented hepatic and diaphragmatic lacerations and transmural laceration of the small intestine. The wound on the upper limb had a significant section of muscle fibers with active arterial hemorrhage, which was ligated. The patient was later admitted to the intensive care unit for monitoring. Comments Traumatic spinal cord injury often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians, since they encounter several issues that may affect several organs and that can go unnoticed in a primary evaluation. References Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, Birk HS, Chan AK, Dhall SS. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017 Nov;43(5):E19. doi: 10.3171/2017.7.FOCUS17396. PMID: 29088951.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Poster Session 7
Polytrauma

Appointment

Chairs

Programme

Poster Session 7Polytrauma

Appointment

Chairs

Programme

Poster Session 7
Polytrauma