Surgical consequences of the Polytrauma Equivalent Syndrome (PES) at the spleen injuries treatment

G. Ács, A. Furka, T. Lesznyák, I. Furka, I. Mikó

Research output: Contribution to journalArticle

Abstract

The injuries are the leading causes of the death at childhood and at the most active adult age-group preceding the cardiovascular cases and tumors. These facts give us the reason for examining the possibilities of reducing the severity and fatal outcome. How can we describe the severity of the injury and the probability of the outcome? Certain scoring-systems try to give the answer by using anatomical and physiological parameters. Is there any reason for the usage of combined scores which contains dynamic and static components too? In the chain of survival the nowadays useable definitions and scoring-systems have got only limited results. Are the polytraumatized ones in the biggest life-danger? After the examination of the polytraumatized patients in Hajdü-Bihar county in the period 1996-2000, the analysis of the severe injured patients' prehospital care in 1999, first in 2000 we proposed a new definition: Polytrauma Equivalent Syndrome (PES). We can rank in this group patients with single or multiple injuries that can lead to multiple organ failure, the ISS score of them is more than 18 and strategy of the treatment is similar to the polytraumatized one. The PES index is the ratio of the increasing and decreasing factors of the severity. In fact of an injury, not only the injury itself determines the survival chance, but the alterations and conditions the patient's already have got at the time of the injury, and the reactions started by the injury's stress and tissue damage. The injuries of the abdominal organs can occur as a monotrauma, but they can be a part of multiple injuries. We processed data of the therapy of persons who severe injured in Hajdu-Bihar county in 1999. Here we have found 256 severe injured patients, and at 42 of them arise the possibility of abdominal injury. By the data of the hospitals between 1996-2000 97 spleen injured were treated, in 91 cases were splenectomy and in 71 cases autotransplantation attached to it. If it's possible we have to save the spleen or at least a part of the spleen by using bioplasts or by the Furka type interlacing suture line. If we haven't got any possibilities to do it, the Furka type spleen apron method seems like an optimal solution, where we make 20x10x1 mm size spleen chips from the spleen and we put them between the two sheets of the great omentum. The spleen injury can be directly critical itself, the adequate prehospital and preoperative trauma management and using of new operative methods makes the possibility to choose the most optimal solution to exempts the patient from the harmful consequences of the splenectomy.

Original languageEnglish
Pages (from-to)454
Number of pages1
JournalLangenbeck's Archives of Surgery
Volume386
Issue number6
Publication statusPublished - 2001

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Multiple Trauma
Spleen
Wounds and Injuries
Abdominal Injuries
Splenectomy
Therapeutics
Organ Dysfunction Scores
Injury Severity Score
Omentum
Fatal Outcome
Survival
Multiple Organ Failure
Autologous Transplantation
Sutures
Cause of Death
Patient Care
Age Groups

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical consequences of the Polytrauma Equivalent Syndrome (PES) at the spleen injuries treatment. / Ács, G.; Furka, A.; Lesznyák, T.; Furka, I.; Mikó, I.

In: Langenbeck's Archives of Surgery, Vol. 386, No. 6, 2001, p. 454.

Research output: Contribution to journalArticle

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abstract = "The injuries are the leading causes of the death at childhood and at the most active adult age-group preceding the cardiovascular cases and tumors. These facts give us the reason for examining the possibilities of reducing the severity and fatal outcome. How can we describe the severity of the injury and the probability of the outcome? Certain scoring-systems try to give the answer by using anatomical and physiological parameters. Is there any reason for the usage of combined scores which contains dynamic and static components too? In the chain of survival the nowadays useable definitions and scoring-systems have got only limited results. Are the polytraumatized ones in the biggest life-danger? After the examination of the polytraumatized patients in Hajd{\"u}-Bihar county in the period 1996-2000, the analysis of the severe injured patients' prehospital care in 1999, first in 2000 we proposed a new definition: Polytrauma Equivalent Syndrome (PES). We can rank in this group patients with single or multiple injuries that can lead to multiple organ failure, the ISS score of them is more than 18 and strategy of the treatment is similar to the polytraumatized one. The PES index is the ratio of the increasing and decreasing factors of the severity. In fact of an injury, not only the injury itself determines the survival chance, but the alterations and conditions the patient's already have got at the time of the injury, and the reactions started by the injury's stress and tissue damage. The injuries of the abdominal organs can occur as a monotrauma, but they can be a part of multiple injuries. We processed data of the therapy of persons who severe injured in Hajdu-Bihar county in 1999. Here we have found 256 severe injured patients, and at 42 of them arise the possibility of abdominal injury. By the data of the hospitals between 1996-2000 97 spleen injured were treated, in 91 cases were splenectomy and in 71 cases autotransplantation attached to it. If it's possible we have to save the spleen or at least a part of the spleen by using bioplasts or by the Furka type interlacing suture line. If we haven't got any possibilities to do it, the Furka type spleen apron method seems like an optimal solution, where we make 20x10x1 mm size spleen chips from the spleen and we put them between the two sheets of the great omentum. The spleen injury can be directly critical itself, the adequate prehospital and preoperative trauma management and using of new operative methods makes the possibility to choose the most optimal solution to exempts the patient from the harmful consequences of the splenectomy.",
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