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Background: Giant ventral hernia occurs after failure to achieve formal fascial closure after laparotomy. This condition needs further treatment for closure while the techniques very among institutes. Objective: This study aims to review the treatment and the results of giant ventral hernia closure after trauma laparotomy at Songklanagarind hospital where is a level 1 trauma center in Thailand. Materials and Methods: A retrospective review of all trauma patients who had giant ventral hernia closure between January 2007 and December 2014. The repair techniques, type of mesh and results were collected. Results: Forty-six patients underwent giant ventral hernia repair. The median age was 33 years. Ninety-one percent was mesh repair and 7% was tissue repair. Composite mesh was most commonly used (93%). The median follow-up time was 598 days (IQR 228 to 1356 days; longest, 2031 days). Surgical site infection occurred in 4 cases (9%) but only one needed surgical intervention for mesh infection. There was one recurrence (2%). Conclusions: Mesh repair is safe for giant ventral hernia closure. Serious mesh-related infection and recurrence were rare. [ABSTRACT FROM AUTHOR]

Objective: The three southern border provinces of Thailand are prone to frequent terrorist attacks. A large number of ensuing deaths and disabilities are reported each year. There is a standard training program (Advanced Trauma Life Support, or ATLS) to prepare emergency room (ER) doctors to take care of patients with acute injuries. The objective of this study was to improve the standard of care provided by ER physicians using the ATLS training course. Methods: An ATLS training course was set in the southern part of Thailand to train ER physicians from the three southern border provinces. Results: Of the 32 participants (2 courses), 17 failed their pre-training examination but only 11 failed in the post-training examination. All participants passed the practical skills examination. Conclusion: This result suggested that ER doctors who are working in the three southern border provinces needed extra training to improve their management of trauma patients. The ATLS course can improve their abilities and confidence in the management of severe injuries. [ABSTRACT FROM AUTHOR]

Background: The treatment outcome of severe trauma victims can be improved by the early presence of the trauma team under leadership of an expert trauma surgeon in the emergency room. The criteria for trauma team activation was the presence of patients at risk or need critical care. This study aimed to evaluate a trauma team activation criteria after implementation at the Songklanagarind Hospital, a level I trauma center. Materials and Methods: Adult trauma patients (age ≥ 15 years) who directly came to Songklanagarind Hospital from January to December 2009 and met at least one of the trauma team activation criteria were enrolled. The criteria consisted of (I) penetrating injury to the chest or the abdomen, (II) systolic blood pressure ≤ 90 mmHg, (III) pulse rate > 120 beat per minute, (IV) respiratory rate <10 or > 30/min, (V) severe head injury (GCS score ≥ 8) and (VI) trauma arrest. Data were retrieved from the trauma registry and descriptive reports. Results: One hundred and fifty-three patients met inclusion criteria. The mean age was 33 ± 13 years. The majority of patients were male (85%) and the average ISS was 18. The most common criteria for activation was pulse rate > 120 bpm (37%). The activation occurred in 52 percent of patients who met the criteria and the surgeon presented at resuscitation room in 75 percent. The procedures which commonly performed in the ER were endotracheal intubation and central venous catheterization (43%). Fifty-seven patients (37%) received emergency operation and the most common operation was exploratory laparotomy (23%). Rate of emergency operation was high in patients presented with hypotension (61%) followed by penetrating torso injury (48%). The mortality rate was high in severe head injury patients (43%). All patients who present with cardiac arrest died. The average length of hospital stay was 14 days. One hundred and two patients (67%) survived until discharge. Conclusions: The majority of severely trauma patients who met the trauma team activation criteria survived until discharge. The activation occurred in about half of them and the surgeon can present in the emergency department in the majority of cases at our hospital In 2004 the authers organized a regional health care system to develop pre-hospital health care system. Rate of emergency operation was high in patients presented with hypotension or penetrating torso injury. Trauma arrest and severe head injury patients had high mortality rate. Good compliance with the criteria may translate to improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Lower extremities arterial injury lead to high morbidity. The number of patients with lower vascular injury is still high especially in southern of Thailand. We have fewer reports about these and limbsalvage surgery is not suitable for all patients. Objective: This study aims to clarify the success rate of limb salvage surgery in patients with lower extremities arterial injury, associated factors and outcomes. Materials and Methods: This retrospective study of lower extremities arterial injury patients that received treatment in Prince of Songkla University from 2013-2017. Patients were classified into limb salvageable group and amputation group. Demographics, comorbidities, injury, operative data and complications were collected. Comparisons of limb salvageable and associated factors were analyzed using the Pearson chi-square or Fisher's exact test. Logistic regression analysis was performed to evaluate factors that may be associated with amputation. Results: 93 patients, 59 (63%) patients were successful in limb salvage surgery. The common site of injury was popliteal artery (49%) and Superficial femoral artery (16%) respectively. We found significant associated factors to limb salvageable such as blunt mechanism (limb salvageable group, 50.8%; amputation group, 76.47% P = 0.01), multiple injuries (limb salvageable group, 15.25%; amputation group, 35.29% P = 0.04), complex fractures (limb salvageable group, 39.13%; amputation group, 15.63% P = 0.02) and smoking (limb salvageable group, 39.13%; amputation group, 15.3% P = 0.04). After multivariate analysis, blunt mechanism injury is only the predictive factor for amputation (OR, 5.2; 95% CI 1.40-19.06; P = 0.01). The common complications were surgical site infection (limb salvageable group, 20.34%; amputation group, 35.29% P = 0.142) and fail to perform skin closure of fasciotomy wound (limb salvageable group, 39.13%; amputation group, 15.63% P = 0.02). Conclusion: Most patients with lower extremities vascular injury were successful in limb salvage surgery. However, our study found a higher amputation rate compared with previous studies. Limb salvageable was associated with blunt mechanism, multiple injuries, smoking and complex fractures. [ABSTRACT FROM AUTHOR]