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Learning objectives To understand: The importance of physiology over anatomy in the • management of trauma The gross surgical anatomy of the chest and abdomen • The pathophysiology of torso injury • The clinical assessment in the injured patient • The use of s...

Management The operative management of liver injuries can be summarised as ‘the four Ps’: /uni25CF Pressure; /uni25CF Pringle; /uni25CF Plug; /uni25CF Pack. At laparotomy the liver is reconstituted and bleeding is con - trolled by direct bimanual compression ...

Planned emergency thoracotomy Planned emergency thoracotomy implies an emergency thora cotomy performed as a planned procedure in the operating theatre, directed at the management of a specific injury . As such, the approach c hosen is dependent on the indicati...

Potentially life-threatening injuries Thoracic aortic disruption Traumatic aortic rupture is a common cause of sudden death after a vehicle collision or fall from a great height. The vessel is relatively fixed distal to the ligamentum arteriosum, just distal t...

Rectum Approximately 5% of colon injuries involve the rectum. These are generally from a penetrating injury , although occasionally the rectum may be damaged following fracture of the pelvis. Digital rectal examination will reveal the pres ence of blood, whi...

Renal and urological tract injury In physiologically non-compromised patients, CT scanning with contrast is the investigation of choice. For assessment of bladder injury a cystogram should be performed at the time of CT . A minimum of 300 /uni00A0 mL of co...

Retroperitoneum Injury to the retroperitoneum is often di ffi cult to diagnose, especially in the presence of other injury , when the signs may be masked. Diagnostic tests (such as ultrasound and DPL) may be negative. The best diagnostic modality is CT , but th...

Small bowel The small bowel is frequently injured as a result of blunt trauma. - The individual loops may be trapped, causing high-pressure rupture of a loop or tearing of the mesentery . Penetrating trauma is also a common cause of injury . control takes...

Spleen Splenic injury occurs from direct blunt trauma. Most isolated splenic injuries, especially in children, can be managed non-operatively . However, in adults, especially in the presence of other injury or physiological compromise, laparotomy should be co...

Stomach Most stomach injuries are caused by penetrating trauma. Blood presence is diagnostic if found in the nasogastric tube, in the absence of bleeding from other sources. Surgical repair is required but great care must be taken to examine the stomach full...

Summary In summary , a haemodynamically normal patient can be safely transferred for stabilisation of unstable fractures within hours after injury and following control of the associated damage. Pelvic injury /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Asso...

THE PEL VIS Although mortality following severe pelvic fractures has decreased dramatically with better methods of controlling haemorrhage, these patients still represent a significant challenge to every link of the treatment chain. Mortality rates exceeding ...

THORACIC INJURY Thoracic injury accounts for 25% of all severe injuries. In a - further 25%, it may be a significant contributor to the subse - quent death of the patient. In most of these patients, the cause of death is haemorrhage. In excess of 80% of p...

ABNORMAL WOUND HEALING Various factors can adversely a ff ect wound healing ( Summary box 3.1 ). Some wounds fail to heal in a timely and orderly manner, resulting in chronic non-healing wounds, signifi cant morbidity and poor cosmesis. On the other hand, Summa...

ACUTE WOUNDS Bites Most bites involve either puncture wounds or avulsions. Wounds over the metacarpophalangeal joint should be treated as a human bite following a punch to the mouth until proven Victor-Auguste-François Morel-Lavallée , 1811–1865, surgeon who fi...

Acute compartment syndrome Acute compartment syndrome occurs when there is increased interstitial pressure within a closed osteofascial compartment, which results in microvascular compromise. It is a surgical emergency as delayed treatment may lead to irrevers...

CHRONIC WOUNDS These wounds fail to progress through the normal stages of wound healing in a timely manner. They are often characterised by a prolonged inflammatory phase and persistent infections. The management of chronic wounds therefore often involves Jean...

CLASSIFICATION OF WOUNDS Wounds are diverse and there is no standard classification system that incorporates all relevant aspects for di ff erent clinical contexts. A wide variety of classifications ( Summary box 3.3 are used and descriptors from more than one s...