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Surg.cal Science 2022年第4期13卷 222-233页

作者： Samantha A. Delapena luis g. fernandez Devin O’Connor Katharine A. Dishner Marc R. Matthews St. Joseph’s Medical Center/Valleywise Health Medical Center Creighton University Phoenix Arizona USA University of Texas Health Science Center Tyler Texas USA Dartmouth Colleg. Hanover New Hampshire USA University of Arizona and Creig.ton University Schools of Medicine Phoenix Arizona USA

A physiolog.c amputation is an important option for the critically ill patient who has irreversible limb disease with necrotic wounds but who would have a low probability of surviving.a standard open amputation, without effective preoperative resuscitation, antibiotics, and correction of metabolic derang.ments. An open amputation may be required secondary to vascular ischemic disease, necrotizing.fasciitis, or thermal injury that has led to the critical and unstable condition. The physiolog.c amputation stabilizes the patient while preventing.further metabolic deterioration. The cryoamputation is intended to rescue the patient’s life and is not meant for limb salvag.. While physiolog.c amputation has been described for over a century, it is uncommonly performed. This case report describes a physiolog.c amputation in a step-by-step fashion for the surg.on attempting.to save a critically ill patient’s life who mig.t not otherwise survive an open amputation.

关键词： Physiolog.c Amputation Cryoamputation Critically Ill Sepsis Septic Shock Cryoanesthesia Amputation Medical Amputation

Reimag.ning.the Visceral Protective Layer with Tailored Manipulation: A Case Report

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Surg.cal Science 2022年第2期13卷 53-65页

作者： R. Dewayne Edwards luis g. fernandez Sean O’Keefe Michelle Baribault Marc R. Matthews Burn Surg.ry and Surg.cal Critical Care The Arizona Burn Center Phoenix AZ USA Department of Surg.ry University of Texas Health Science Center Tyler TX USA 3M Phoenix AZ USA Mountain Vista Medical Center Mesa AZ USA The Arizona Burn Center Phoenix AZ USA

The visceral protective layer is a standard component of the ABTHERATM systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral protective layer is too larg. to be successfully applied into every patient’s open abdomen, such as within the abdomen of a child, smaller adult or a patient with previously placed ostomies or drains. The fenestrated, visceral protective layer may require alterations or tailoring.for adequate deployment instead of placing.the bulk of the visceral protective layer entirely into the open abdomen for temporary abdominal closure. This case report illustrates how the visceral protective layer can be adapted or “reimag.ned” to conform to a patient with unique or complex abdominal domain features when utilizing.the ABTHERATM device prior to facial closure or abdominal wall reconstruction. Photog.aphs are utilized in a step-by-step fashion to aid the clinician in these detailed maneuvers.

关键词： Open Abdomen Temporary Abdominal Closure Visceral Protective Layer Loss of Abdominal Domain

The Use of the V.A.C. RX-4 for Multiple Soft Tissue Wound Application in the Sing.e Patient: A Case Report

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Surg.cal Science 2022年第3期13卷 155-163页

作者： Emily R. Kindal Kaitlin J. Larson luis g. fernandez Sean F. O’Keefe Marc R. Matthews Medical Student IV Royal College of Surgeons in Ireland Dublin Ireland Surg.cal Resident The Arrowhead Surgical Residency Glendale Arizona Department of Surg.ry University of Texas Health Science Center Tyler USA Trauma Wound Care UT Health East Tyler USA Department of Surg.ry University of Texas Medical Branch Galveston USA Business Development Manag.r Saint Paul US University of Arizona & Creig.ton University Schools of Medicine The Arizona Burn Center Phoenix Arizona

Contact burn injuries account for a considerable proportion of admissions that frequently require debridement. Such debridements of these multiple open wounds mig.t benefit from the application of neg.tive pressure wound therapy (NPWT) for the removal of proinflammatory mediators and to promote g.anulation tissue with macrostrain and microstrain. Having.four or more Vacuum Assist Closure (V.A.C.) Ulta devices connected to the same patient for adequate wound coverag. is cumbersome in the manag.ment of the patient’s wound care and tethers the patient to the bed. The V.A.C. RX-4 is a multichannel device that can deliver NPWT with a smaller footprint. In addition, the V.A.C. RX-4 has a weig.t of 16 lbs. versus one V.A.C Ulta which is 7.4 lbs. Therefore, collectively, four V.A.C. Ultas would equal 29.6 lbs. or almost double the weig.t of a sing.e V.A.C. RX-4. Use of the V.A.C. RX-4 by healthcare providers can mean g.eater mobility for the patient and easier transport between patient destinations within the hospital. This case report demonstrates the utility of the V.A.C. RX-4 for open and freshly debrided, larg. soft tissue wounds in a burn patient.

关键词： V.A.C. RX-4 Neg.tive Pressure Wound Therapy Wounds V.A.C. Ulta Footprint Burns

First Reported Incidence of Delayed Secondary Abdominal Compartment Syndrome in a Trauma Patient with Scleroderma: A Case Report and Review of the Literature

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Surg.cal Science 2022年第4期13卷 234-245页

作者： luis g. fernandez Mohamed I. Abdelg.wad Mahmoud Omar Marc R. Mathews Scott H. Norwood Alan D. Cook Rebecca Swindall Carly Wadle Department of Surg.ry UT Health East Texas Tyler TX USA Department of Surg.ry Tulane University School of Medicine New Orleans LA USA Arizona Burn Center Creighton University Phoenix AZ USA Department of Epidemiolog. and Biostatistics University of Texas Health Science Center Tyler TX USA

Backg.ound: Scleroderma is a complex immune-mediated rheumatic disease that is characterized by fibrosis of the skin, internal org.ns, and vasculopathy. Extensive fibrosis, especially in the limited compartment, has been reported to induce acute compartment syndrome frequently reported involving.the upper and lower extremities. Case Presentation: We present a rare case of a 54-year-old Caucasian female who underwent surg.ry for abdominal compartment syndrome in the setting.of scleroderma. Upon arrival, at the hospital, the patient’s health status showed sig.s of improvement with no indicators of abdominal compartment syndrome until the tenth hospital day. A CT scan showed a new intra-abdominal fluid collection with total lower abdominal anasarca and a stable retroperitoneal hematoma. Following.emerg.ncy surg.ry, sig.ificant bowel edema without other intra-abdominal injuries was noted. Conclusion: Secondary abdominal compartment syndrome may occur in patients with scleroderma without evidence of intra-abdominal trauma or emerg.nt abdominal surg.ry. Further research is warranted to investig.te the relationship between scleroderma and secondary abdominal compartment syndrome.

关键词： Scleroderma Secondary Abdominal Compartment Syndrome Trauma

Necrotizing.Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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Surg.cal Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena luis g. fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews Colleg. of Medicine-Phoenix University of Arizona Phoenix AZ USA Creig.ton University Arizona Health Education Alliance Phoenix AZ USA Department of Surg.ry Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surg.ry Tyler TX USA Trauma Wound Care UT Health East Tyler TX USA Department of Surg.ry University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of Medicine and Nursing University of Texas Arlington TX USA Past Commanding.g.neral TXSg.Medical Brig.de Austin TX USA Surg.cal Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales Manag.r Miach Orthopedics Surg.cal Acute Account Manag.r 3M Minneapolis MN USA Clinical Professor of Surg.ry Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of g.s in the g.llbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from g.s-forming.org.nisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the g.llbladder and the skin, is also a rare complication of g.llbladder disease. We describe a case of a 77-year-old male who presented with rig.t flank necrotizing.fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the larg. open wound was treated with neg.tive pressure wound therapy with instillation (NPWT-i) utilizing.hypochlorous acid (HOCL). The wound was closed with a split-thickness skin g.aft.

关键词： Emphysematous Cholecystitis g.ng.enous Cholecystitis Cholecystocutaneous Fistula Necrotizing.Fasciitis Sepsis

Utilizing.Instilling.Neg.tive Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

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Surg.cal Science 2023年第3期14卷 231-239页

作者： Linnea T. Mauro Courtney M. Janowski Mariah J. Janowski Adalberto C. g.nzalez Eug.ne J. Sidoti luis g. fernandez Paul J. Kim Marc R. Matthews Valleywise Medical Center Department of Surgery Phoenix Arizona Department of Surg.ry Division of Trauma Surgery/Surgical Critical Care University of Texas Health Science Center Tyler Texas The University of Texas Tyler School of Medicine Endowed Chair in Trauma Surgery Tyler Texas Trauma Wound Care UT Health East Tyler Texas Department of Surg.ry University of Texas Medical Branch Galveston Texas Medicine and Nursing University of Texas Arlington Texas Department of Medical Education Health Science Center Tyler Texas Department of Physician Assistant Studies School of Health Professions University of North Texas Fort Worth Texas ACS National Committee on Trauma Chicago USA Plastic Surg.ry Department of Surgery University of Texas Southwestern Dallas Texas University of Arizona & Creig.ton University Schools of Medicine The Arizona Burn Center Phoenix Arizona

Utilization of neg.tive pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surg.ry has become an accepted therapy. NPWTi accelerates wound healing.throug. macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorg.nisms, the release of proinflammatory mediators, stimulation of ang.og.nesis, as well as mechanical debridement. However, very few cases of utilizing.NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

关键词： Neg.tive Pressure Wound Therapy with Instillation NPWT NPWTi NPWT with Dwell Hypochlorous Acid Vashe Wound Solution Sternal Dehiscence

Troubleshooting.a Difficult Trans-Tibial/Fibula Amputation: A Case Report

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Surg.cal Science 2023年第6期14卷 414-427页

作者： Amy C. Ross Alejandra Navarro Castaneda Jared D. Stucki Katharine A. Dishner Marisse A. Lardizabal Bryan J. Roth luis g. fernandez Samantha A. Delapena Marc R. Matthews Department of Podiatry Valleywise Health Medical Center Phoenix Arizona USA Department of Surg.ry Arrowhead Medical Center Glendale Arizona USA Department of Surg.ry Mountain Vista Medical Center Mesa Arizona USA Valleywise Health Medical Center Phoenix Arizona USA Department of Surg.ry Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler Texas USA School of Medicine Bill Barrett Endowed Chair in Trauma Surg.ry The University of Texas-Tyler Tyler Texas USA Trauma Wound Care UT Health East Tyler Texas USA Department of Surg.ry University of Texas Medical Branch Galveston Texas USA Department of Medicine and Nursing University of Texas Arlington Texas USA Past Commanding.g.neral TXSg.Medical Brig.de Austin Texas USA Department of Surg.ry Weill Cornell Medical Center New York NY USA Department of Surg.ry New York Presbyterian Hospital New York NY USA Department of Surg.ry Banner University of Arizona/University Medical Center Tucson Arizona USA

Necrotic feet secondary to vascular compromise in the diabetic patient may require an emerg.nt g.illotine amputation. Unrecog.ized, retained hardware in a distal ankle years after fracture repair may complicate the intraoperative g.illotine amputation at the transtibial/fibula level. Troubleshooting.such an unexpected surg.cal problem is not necessarily straig.tforward depending.on the clinical situation. Presented is a case report where a patient with a necrotic burned foot failed to inform the burn team that he had implanted ankle hardware, prior to his surg.cal intervention. A successful amputation was completed after proceeding.down a specific alg.rithm devised for such a scenario.

关键词： g.illotine Amputation Difficult Amputation Amputation Retained Hardware Titanium Plate Trans-Tibia Amputation

Necrotizing.Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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Erythropoietin modulates bone marrow stromal cell differentiation

Surg.cal Science 2023年第5期

作者： Alexandra N. Dominianni Samantha A. Delapena luis g. fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews

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Bone Research 2019年第3期7卷 272-285页

作者： Sukanya Suresh luis fernandez de Castro Soumyadeep Dey Pamela g. Robey Constance Tom Nog.chi Molecular Medicine Branch National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD 20892 USA Skeletal Biolog. Section National Institute of Dental and Craniofacial Research National Institutes of Health Bethesda MD 20892 USA

Erythropoietin is essential for bone marrow erythropoiesis and erythropoietin receptor on non-erythroid cells including.bone marrow stromal cells sug.ests systemic effects of erythropoietin. Tg. mice with chronic erythropoietin overexpression have a hig. hematocrit, reduced trabecular and cortical bone and bone marrow adipocytes, and decreased bone morphog.nic protein 2 driven ectopic bone and adipocyte formation. Erythropoietin treatment(1 200 IU·kg.1) for 10 days similarly exhibit increased hematocrit,reduced bone and bone marrow adipocytes without increased osteoclasts, and reduced bone morphog.nic protein sig.aling.in the bone marrow. Interesting.y, endog.nous erythropoietin is required for normal differentiation of bone marrow stromal cells to osteoblasts and bone marrow adipocytes.ΔEpoR_E mice with erythroid restricted erythropoietin receptor exhibit reduced trabecular bone, increased bone marrow adipocytes, and decreased bone morphog.nic protein 2 ectopic bone formation. Erythropoietin treated ΔEpoR_E mice achieved hematocrit similar to wild-type mice without reduced bone, sug.esting.that bone reduction with erythropoietin treatment is associated with non-erythropoietic erythropoietin response. Bone marrow stromal cells from wild-type,Tg., and ΔEpoR_E-mice were transplanted into immunodeficient mice to assess development into a bone/marrow org.n. Like endog.nous bone formation, Tg. bone marrow cells exhibited reduced differentiation to bone and adipocytes indicating.that hig. erythropoietin inhibits osteog.nesis and adipog.nesis, while ΔEpoR_E bone marrow cells formed ectopic bones with reduced trabecular reg.ons and increased adipocytes, indicating.that loss of erythropoietin sig.aling.favors adipog.nesis at the expense of osteog.nesis. In summary, endog.nous erythropoietin sig.aling.reg.lates bone marrow stromal cell fate and aberrant erythropoietin levels result in their impaired differentiation.

关键词： bone marrow adipocyte normal differentiation

Troubleshooting.a Difficult Trans-Tibial/Fibula Amputation: A Case Report

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