36 results on '"Fries CA"'
Search Results
2. CrossFitter’s knee: patellofemoral chondral injury following high-intensity functional training
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Jackson, J, primary, Hart, S, additional, Fries, CA, additional, Robinson, J, additional, Murray, J, additional, and Wood, A M, additional
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- 2017
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3. Hyperbaric Sub-Normothermic Ex-Vivo Perfusion Delays the Onset of Acute Rejection in a Porcine VCA Model
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Michael R. Davis, S.D. Lawson, L.C. Wang, and Fries Ca
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medicine.medical_specialty ,Text mining ,business.industry ,Anesthesia ,Ex vivo perfusion ,medicine ,Surgery ,business - Published
- 2015
4. Surgical Training in Camp Bastion, Afghanistan
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Fries, CA, primary and Rickard, RF, additional
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- 2012
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5. Aggressive Soft Tissue Infections and Amputation in Military Trauma Patients
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Penn-Barwell, JG, primary, Fries, CA, additional, Sargeant, ID, additional, Bennett, PM, additional, and Porter, K, additional
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- 2012
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6. Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients.
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Malekpour M, Tozzi F, Walker J, Fries CA, and Hosein RC
- Abstract
Background: Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population., Methods: We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed., Results: Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction., Conclusions: Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
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- 2023
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7. Orthoplastic Treatment of Open Lower-Limb Fractures Improves Outcomes: A 12-Year Review.
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D'Cunha EM, Penn-Barwell JG, McMaster J, and Fries CA
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- Humans, Fracture Fixation, Internal methods, Retrospective Studies, Surgical Flaps, Treatment Outcome, Tibial Fractures surgery, Fractures, Open surgery
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Background: The British Orthopaedic Association Standards for Orthopaedics and Trauma 4 (BOAST 4) inform the management of open lower-limb fractures. The authors conducted repeated reviews of performance against these standards over a 12-year period. This latest iteration has shown further improvements in outcomes concomitant with changes in service delivery., Methods: Data on Gustilo-Anderson grade IIIB or IIIC open lower-limb fractures were collected from a prospectively constructed departmental database and analyzed using Excel. Outcomes assessed included time to stabilization, time to definitive soft-tissue coverage, and deep infection rates., Results: A total of 69% of patients in our cohort received care that aligned with BOAST 4 guidelines. Median time to stabilization was 14.2 hours and to soft-tissue coverage was 47 hours, with 71% of cases compliant with BOAST 4 guidelines. The overall deep infection rate was 6.5% in our cohort. There was a significantly lower deep infection rate in BOAST 4-compliant cases (2%) versus noncompliant cases (16%), respectively (P = 0.05). A total of 41 of 61 patients had fixation and soft-tissue coverage in a single operation (fix and flap), eight had staged operations, and 12 required local flap closure. There was no significant difference in deep infection rates among these approaches., Conclusions: Compliance with the BOAST 4 guidelines and time to definitive soft-tissue coverage have improved at our center since the last review. Deep infection rates were significantly lower in BOAST 4-compliant cases, further validating this approach. The fix and flap technique was introduced during the study period and reduces operative burden for patients. These results support a joint orthoplastic approach as the optimal management for these complex injuries., Clinical Question/level of Evidence: Therapeutic, IV., Competing Interests: Disclosure: The authors have no financial interests or conflicts of interest to declare in relation to the content of this article., (Copyright © 2022 by the American Society of Plastic Surgeons.)
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- 2023
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8. Vascularised composite allotransplantation in solid organ transplant recipients: A systematic review.
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Honeyman C, Stark HL, Fries CA, Gorantla VS, Davis MR, and Giele H
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- Humans, Postoperative Complications epidemiology, Treatment Outcome, Graft Rejection prevention & control, Immunosuppressive Agents therapeutic use, Vascularized Composite Allotransplantation methods
- Abstract
Introduction: A solid organ transplant (SOT) recipient, already taking immunosuppression, may represent the ideal candidate for vascularised composite allograft transplantation (VCA). However, concerns have been raised about the potential risk of SOT loss or the need for increased immunosuppression to sustain the VCA. This systematic review examines all published cases of SOT recipients who have received a VCA to establish associated morbidity and immunosuppression requirements., Methods: A systematic review was performed in accordance with the PRISMA guidelines. The PubMed, MEDLINE and EMBASE databases were searched for original articles published between January 1997 and May 2019. Only articles relating to patients who had received both a VCA and SOT with a reported follow up of greater than six months were included., Results: Fifteen articles were identified, including data from 39 VCAs in 37 patients. There was no increase in the number of SOT rejection episodes, complications such as post-transplant lymphoproliferative disorder or graft versus host disease, de novo donor specific HLA antibodies or short-term risks to the recipient when compared with SOT in isolation. One child required a sustained increase in their baseline immunosuppression following bilateral hand transplantation., Conclusions: In this small heterogeneous cohort, the addition of a VCA to a SOT does not appear to increase the short-term risks to the SOT or the patient with comparable results to SOT in isolation. However, data are often poorly reported and longer-term follow up and uniform reporting of outcomes would be beneficial to more accurately assess the safety profile of combining VCA with SOT., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2021
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9. Trends in Decubitus Ulcer Disease Burden in European Union 15+ Countries, from 1990 to 2017.
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Goodall R, Armstrong A, Hughes W, Fries CA, Marshall D, Harbinson EB, Salciccioli J, and Shalhoub J
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Decubitus ulcers (DU) are a common pathology with significant morbidity and financial implications for health services globally. This study aimed to compare the burden of DU across European Union (EU) 15+ countries between 1990 and 2017., Methods: Age-standardized incidence, mortality, and disability-adjusted life-years (DALYs) rates per 100,000 were extracted from the Global Burden of Disease Study online data repository for EU15+ countries (a group of 19 countries with comparable health expenditure, including the United States, Canada, the United Kingdom, and Australia). A joinpoint regression analysis was used to describe trends., Results: The incidence of DU increased between 1990 and 2017 in 15 of 19 EU15+ countries for both men and women. Mortality from DU decreased over the time period analyzed in the majority of EU15+ countries: only in Denmark, Finland, and Germany were increasing mortality rates observed. Decreasing DALY rates were generally observed, with the largest decreases observed in Ireland for men and women. Denmark and Germany were the only countries to demonstrate unfavorable trends in mortality, incidence, and DALYs between 1990 and 2017 for men and women. The United States, the Netherlands, and France were the only EU15+ countries in which improving disease burden was identified between 1990 and 2017 for all parameters assessed., Conclusions: Incidence of DU is increasing in EU15+ countries, whereas mortality rates and DALYs are improving. The trends in disease burden in Denmark and Germany have followed contrasting and unfavorable trends. Investigation into these trends is called for., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2020
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10. Change in the Face of the COVID-19 Pandemic: Shaping Plastic Surgery Services of the Future.
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Shaw AV, Goodall R, Armstrong A, and Fries CA
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- COVID-19, Humans, Pandemics, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Pneumonia, Viral epidemiology, Plastic Surgery Procedures trends, Surgery, Plastic trends
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- 2020
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11. Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic-results from an observational study at the Oxford Sarcoma Service.
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Rajasekaran RB, Kotecha S, Whitwell D, Cosker TDA, Critchley P, Fries CA, Pigott D, Gibbons CLMH, and Carr A
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, SARS-CoV-2, Sarcoma pathology, Sarcoma surgery, Young Adult, Bone Neoplasms surgery, COVID-19, Pandemics, Patient Safety, Soft Tissue Neoplasms surgery
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Purpose: Deferring cancer surgery can have profound adverse effects including patient mortality. During the COVID-19 pandemic, departmental reorganisation and adherence to evolving guidelines enabled provision of uninterrupted surgical care to patients with bone and soft tissue tumours (BST) in need of surgery. We reviewed the outcomes of surgeries on BST during the first two months of the pandemic at one of the tertiary BST centres in the UK., Materials and Methods: Between 12 March 2020 and 12 May 2020, 56 patients of a median age of 57 years (18-87) underwent surgery across two sites: index hospital (n = 27) and COVID-free facility (n = 29). Twenty-five (44.6%) patients were above the age of 60 years and 20 (35.7%) patients were in ASA III and ASA IV category. The decision to offer surgery was made in adherence with the guidelines issued by the NHS, BOOS and BSG., Results: At a minimum follow-up of 30 days post-surgery, 54 (96.4%) patients were recovering well. Thirteen patients (23.2%) had post-operative complications which included four (7.1%) patients developing pulmonary embolism. The majority of complications (12/13 = 92.7%) occurred in ASA III and IV category patients. Four (7.1%) patients contracted COVID-19, of which three required escalation of care due to pulmonary complications and two (3.6%) died. Patients < 60 years of age had significantly less complications than those > 60 years (p < 0.001). Patients operated on in the COVID-free facility had fewer complications compared with those operated on at the index hospital (p < 0.027)., Conclusion: In spite of the favourable results in majority of our patients, our study shows that patients with sarcoma operated at the height of the pandemic are at a risk of contracting COVID-19 and also having associated with mortality. The use of a COVID-free facility, surgery in patients < 60 60 years and in ASA I & II category are associated with better outcomes. If a second wave occurs, a serious consideration should be given to ways of minimising the risk of contracting COVID-19 in these vulnerable patients either by using COVID-free facilities or delaying treatment until peak of infection has passed.
- Published
- 2020
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12. Translational techniques from cleft to cosmetic rhinoplasty.
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Stark HL, Fries CA, and Mercer NS
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- 2020
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13. Complete laparoscopic removal of retropubic midurethral tape (tension-free vaginal tape) from the obturator nerve: a multidisciplinary approach.
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Cooke WR, Cartwright R, Fries CA, and Price N
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- Female, Humans, Middle Aged, Patient Care Team, Device Removal methods, Laparoscopy, Neuralgia etiology, Obturator Nerve, Postoperative Complications etiology, Postoperative Complications surgery, Suburethral Slings adverse effects
- Published
- 2019
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14. Techniques and outcomes in microsurgical soft palate reconstruction.
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Fries CA, Al Deek N, and Wei FC
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- Adult, Aged, Deglutition, Humans, Microsurgery, Middle Aged, Quality of Life, Retrospective Studies, Speech Intelligibility, Free Tissue Flaps, Palatal Neoplasms surgery, Palate, Soft surgery
- Abstract
Introduction: The soft palate is a multilayered intrinsically mobile structure, with a critical role in maintaining the airway, swallowing, and speech. We describe our technique of microsurgical reconstruction and analyze patient reported outcomes., Methods: A retrospective analysis was performed using the University of Washington head and neck disease specific Quality of Life (UWQOL) questionnaire and the Hirose Standard speech analysis tool. Swallowing function and diet were recorded., Results: Twenty cases were reviewed; nine were available for post hoc analysis. Anterolateral thigh flaps were used in 19 cases, in combination with vastus lateralis muscle in 5 cases. Speech intelligibility was graded "excellent" in 8 of 9 cases and moderate in 1 of 9. All tolerated an oral diet. Mean UWQOL score was 424.4/600 (SD ± 141.9) for physical and 461.7/600 (SD ± 141.9) for emotional-social domains., Conclusion: Reconstruction of the soft palate using velopharyngeal narrowing with free anterolateral thigh flap delivers good functional outcomes., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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15. Patient-Reported Outcome Measures for Toe-to-Hand Transfer: A Prospective Longitudinal Study.
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Tsai TY, Fries CA, Hsiao JC, Hsu CC, Lin YT, Chen SH, Lin CH, Wei FC, and Lin CH
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- Activities of Daily Living, Adult, Esthetics, Female, Humans, Longitudinal Studies, Male, Microsurgery, Middle Aged, Patient Satisfaction, Prospective Studies, Recovery of Function physiology, Finger Injuries surgery, Patient Reported Outcome Measures, Plastic Surgery Procedures methods, Toes transplantation
- Abstract
Background: Patient-reported outcome measures are an important metric in evaluating treatment efficacy of reconstructive surgery. Toe-to-hand transfer can restore vital prehensile function; however, this surgery is complex, extensive rehabilitation is required, and there are concerns about donor-site morbidity. This study longitudinally explores the benefits of this procedure, from the patient's perspective, using patient-reported outcome measures., Methods: Twenty-three patients who underwent free toe-to-hand transfers from 2012 to 2015 were evaluated preoperatively and postoperatively using the following validated questionnaires: the Michigan Hand Outcomes Questionnaire, the 36-Item Short-Form Health Survey, and the Lower Limb Outcomes Questionnaire. Subgroup analysis was performed between dominant and nondominant reconstructed hands., Results: Mechanism of injury was crush in 83 percent; the remainder sustained cutting, avulsion, and burn injuries. Thirty-four toes were transferred: nine great toes, 20 second toes, and five third toes. Michigan Hand Outcomes Questionnaire results showed significant improvement in overall activities of daily living, work, aesthetics, and patient satisfaction (p < 0.05). The results of the 36-Item Short-Form Health Survey showed significant improvements in physical and emotional roles (p < 0.05). The Lower Limb Outcomes Questionnaire showed no deterioration of foot function (p = 0.55). Subgroup analysis showed significant improvement in patient-reported outcome measures for patients undergoing dominant hand reconstruction but no difference between thumb reconstruction and finger-only reconstruction., Conclusions: Patient-reported outcome measures demonstrate the significant utility of toe-to-hand transfer procedures in both functional and psychosocial domains in that there are relatively greater benefits in reconstructing the dominant hand, and that donor-site morbidity is well tolerated., Clinical Question/level of Evidence: Therapeutic, IV.
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- 2019
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16. Composite Graft Pretreatment With Hydrogen Sulfide Delays the Onset of Acute Rejection.
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Fries CA, Lawson SD, Wang LC, Spencer JR, Roth M, Rickard RF, Gorantla VS, and Davis MR
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- Acute Disease, Animals, Disease Models, Animal, Graft Survival, Multivariate Analysis, Preoperative Care methods, Random Allocation, Risk Assessment, Swine, Treatment Outcome, Vascularized Composite Allotransplantation adverse effects, Wound Healing physiology, Composite Tissue Allografts transplantation, Graft Rejection prevention & control, Hydrogen Sulfide pharmacology, Myocutaneous Flap transplantation, Vascularized Composite Allotransplantation methods
- Abstract
Introduction: Vascularized composite allotransplantation can reconstruct devastating tissue loss by replacing like-with-like tissues, most commonly in the form of hand or face transplantation. Unresolved technical and ethical challenges have meant that such transplants remain experimental treatments. The most significant barrier to expansion of this field is the requirement for systemic immunosuppression, its toxicity and effect on longevity.Hydrogen sulfide (H2S) has been shown experimentally to ameliorate the ischemia reperfusion injury associated with composite tissue autotransplantation, which has been linked to acute rejection in solid organ transplantation. In this protocol, a large-animal model was used to evaluate the effect of H2S on acute rejection after composite tissue allotransplantation., Materials and Methods: A musculocutaneous flap model in SLA-mismatched swine was used to evaluate acute rejection of allotransplants in 2 groups: control animals (n = 8) and a treatment group in which the allografts were pretreated with hydrogen sulfide (n = 8). Neither group was treated with systemic immunosuppression. Acute rejection was graded clinically and histopathologically by an independent, blinded pathologist. Data were analyzed by t tests with correction for multiple comparisons by the Holm-Šídák method., Results: Clinically, H2S-treated tissue composites showed a delay in the onset of rejection that was statistically significant from postoperative day 6. Histopathologically, this difference between groups was also apparent, although evidence of a difference in groups disappeared beyond day 10., Conclusions: Targeted hydrogen sulfide treatment of vascularized composite allografts immediately before transplantation can delay acute rejection. This may, in turn, reduce or obviate the requirement for systemic immunosuppression.
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- 2019
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17. Dorsal Wrist Placement for Vascularized Submental Lymph Node Transfer Significantly Improves Breast Cancer-Related Lymphedema.
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Aljaaly HA, Fries CA, and Cheng MH
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Background: Vascularized submental lymph node flap transfer to the wrist is an effective treatment for breast cancer-related lymphedema. Dorsal placement was hypothesized to offer superior outcomes due to favorable venous drainage; however, the flap is more visible in this position compared with the volar side and was a cosmetic concern for patients. This study compared the treatment response of breast cancer-related lymphedema with the placement of vascularized submental lymph node flaps at the wrist, between dorsal and volar recipient sites., Methods: A retrospective longitudinal study examined 15 patients receiving vascularized submental lymph node flaps at the wrist performed by a single surgeon with a mean follow-up of 17 months. Clinical and biometric analyses, including quality of life questionnaires, circumference measurements, and number of infections were conducted., Results: All patients showed improvements in quality of life, reduced episodes of cellulitis, and reduced limb circumference measurements compared with preoperative data. Dorsal placement (n = 7) delivered significant reductions in limb circumference at all levels after 1 year ( P = 0.04) and in overall function domains in the Lymphedema Specific Quality of Life Questionnaires ( P = 0.04) compared with volar placement (n = 8). Venous outflow was greater in the dorsal recipient veins ( P < 0.0001)., Conclusions: Patients electing to undergo vascularized lymph node transfer to the wrist should be aware that when both options are effective, dorsal placement offers improvement in outcomes despite reduced cosmesis. These results have been incorporated into an evidence-based treatment algorithm that can inform the patient and physician on the decision-making in the breast and plastic surgical spheres.
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- 2019
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18. A Hyperbaric Warm Perfusion System Preserves Tissue Composites Ex vivo and Delays the Onset of Acute Rejection.
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Fries CA, Villamaria CY, Spencer JR, Lawson S, Wang L, Raj T, Wolf EG, Parida BK, Gorantla VS, Rickard RF, and Davis MR
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- Animals, Female, Models, Animal, Perfusion, Swine, Allografts physiology, Graft Survival physiology, Hyperbaric Oxygenation methods, Organ Preservation methods, Reperfusion Injury prevention & control
- Abstract
Background: Ischemia-reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA., Methods: A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts ( n = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours. Intervention autografts ( n = 5) were placed in a hyperbaric oxygen organ preservation system for 5 hours and infused with hyperoxygenated UWS at 20°C and 3 atm. Grafts were replanted into the animals' necks. In phase 2, similarly treated control ( n = 8) and intervention grafts ( n = 8) were allotransplanted into the necks of animals separated by a typed and standardized genetic mismatch. No systemic immunosuppression was given. Systemic markers of IRI, and clinical and histopathological assessments of necrosis and rejection were performed., Results: Autotransplanted tissue composites preserved in the hyperbaric chamber showed histopathological evidence of less muscle necrosis at 3 hours ( p = 0.05). Despite a longer period of ischemia, no evidence was found of a difference in systemic markers of IRI following revascularization in these groups. Allotransplanted tissues supported ex vivo within the hyperbaric perfusion device experienced acute rejection significantly later than corresponding controls., Conclusion: Hyperbaric warm perfusion preserves musculocutaneous tissue composites ex vivo for longer than standard cold preservation in this model. This translates into a delay in acute rejection of allotransplanted tissue composites., Competing Interests: C.A. Fries, C.Y. Villamaria, B.K. Parida, J.R. Spencer, V.S. Gorantla, R.F. Rickard, and M.R. Davis have no conflict of interest, and E.G. Wolf is the President of the Hyperbaric Oxygen Organ Preservation Systems., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2019
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19. Graft-implanted, enzyme responsive, tacrolimus-eluting hydrogel enables long-term survival of orthotopic porcine limb vascularized composite allografts: A proof of concept study.
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Fries CA, Lawson SD, Wang LC, Slaughter KV, Vemula PK, Dhayani A, Joshi N, Karp JM, Rickard RF, Gorantla VS, and Davis MR
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- Animals, Drug Implants, Forelimb transplantation, Graft Rejection immunology, Graft Rejection prevention & control, Graft Survival drug effects, Graft Survival immunology, Hydrogels, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents pharmacokinetics, Models, Animal, Proof of Concept Study, Swine, Swine, Miniature, Tacrolimus pharmacokinetics, Composite Tissue Allografts drug effects, Composite Tissue Allografts immunology, Composite Tissue Allografts pathology, Tacrolimus administration & dosage, Vascularized Composite Allotransplantation methods
- Abstract
Background: Currently, patients receiving vascularized composite allotransplantation (VCA) grafts must take long-term systemic immunosuppressive therapy to prevent immunologic rejection. The morbidity and mortality associated with these medications is the single greatest barrier to more patients being able to receive these life-enhancing transplants. In contrast to solid organs, VCA, exemplified by hand or face transplants, allow visual diagnosis of clinical acute rejection (AR), directed biopsy and targeted graft therapies. Local immunosuppression in VCA could reduce systemic drug exposure and limit adverse effects. This proof of concept study evaluated, in a large animal forelimb VCA model, the efficacy and tolerability of a novel graft-implanted enzyme-responsive, tacrolimus (TAC)-eluting hydrogel platform, in achieving long-term graft survival., Methods: Orthotopic forelimb VCA were performed in single haplotype mismatched mini-swine. Controls (n = 2) received no treatment. Two groups received TAC hydrogel: high dose (n = 4, 91 mg TAC) and low dose (n = 4, 49 mg TAC). The goal was to find a dose that was tolerable and resulted in long-term graft survival. Limbs were evaluated for clinical and histopathological signs of AR. TAC levels were measured in serial blood and skin tissue samples. Tolerability of the dose was evaluated by monitoring animal feeding behavior and weight., Results: Control limbs underwent Banff Grade IV AR by post-operative day six. Low dose TAC hydrogel treatment resulted in long-term graft survival time to onset of Grade IV AR ranging from 56 days to 93 days. High dose TAC hydrogel also resulted in long-term graft survival (24 to 42 days), but was not well tolerated., Conclusion: Graft-implanted TAC-loaded hydrogel delays the onset of Grade IV AR of mismatched porcine forelimb VCA grafts, resulting in long term graft survival and demonstrates dose-dependent tolerability., Competing Interests: J.M.K. and P.K.V. hold equity in Alivio Therapeutics, a company that has an option to license IP generated by J.M.K. and P.K.V., and that may benefit financially if the IP is licensed and further validated. The interests of J.M.K. was reviewed and is subject to a management plan overseen by his institution in accordance with its conflict of interest policies. N.J. and K.V.S. have generated IP that has been licensed to Alivio Therapeutics. Other authors declare no conflicts of interest. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
- Published
- 2019
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20. C1 esterase inhibitor ameliorates ischemia reperfusion injury in a swine musculocutaneous flap model.
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Fries CA, Villamaria CY, Spencer JR, Rasmussen TE, and Davis MR
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- Animals, Disease Models, Animal, Female, Swine, Complement C1 Inhibitor Protein therapeutic use, Complement Inactivating Agents therapeutic use, Myocutaneous Flap blood supply, Reperfusion Injury drug therapy
- Abstract
Purpose: Free tissue transfer is a powerful reconstructive surgical technique. The ischemia reperfusion injury (IRI) at revascularization affects the flap and the patient; reducing this insult could improve outcomes. This study evaluated the effect of C1 esterase inhibitor (C1-inh) on IRI in a porcine musculocutaneous flap model., Materials and Methods: A musculocutaneous flap was transferred from the limb to the neck of 12 swine. Flaps underwent a 3-hour ischemic interval prior to revascularization. Intervention group flaps (n = 6) were perfused intra-arterially with 100U C1-inh at the commencement of the ischemic period; controls (n = 6) received heparinized saline solution. Protocol duration was 14 days; markers of reperfusion injury (creatine kinase [CK], aspartate transaminase [AST], tumor necrosis factor-alpha) were evaluated., Results: All flaps from the intervention group were viable at 14 days; five of six control flaps were viable at 14 days (P = 1). Systemic levels of biomarkers of tissue necrosis and inflammation were reduced in the intervention group. On post-operative day one, statistically significant reductions in mean levels of AST and CK were demonstrated (2,293 ± 1 × 10
3 U/L vs. 1,586 ± 767 U/L [P = 0.04] and 429 × 103 ± 214 × 103 U/L vs. 213 × 103 ± 156 × 103 U/L [P = 0.002], respectively). Flaps of both groups healed in their recipient locations, no adverse reactions were observed., Conclusions: C1-inh is protective of IRI and may have utility in free tissue transfer, vascularized composite allotransplantation, and spare parts surgery. © 2016 Crown copyright. Microsurgery © 2016 Wiley Periodicals, Inc. Microsurgery 37:142-147, 2017., (© 2016 Crown copyright. Microsurgery © 2016 Wiley Periodicals, Inc.)- Published
- 2017
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21. Dismounted Complex Blast Injuries: A Comprehensive Review of the Modern Combat Experience.
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Cannon JW, Hofmann LJ, Glasgow SC, Potter BK, Rodriguez CJ, Cancio LC, Rasmussen TE, Fries CA, Davis MR, Jezior JR, Mullins RJ, and Elster EA
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- Amputation, Traumatic etiology, Amputation, Traumatic pathology, Blast Injuries etiology, Blast Injuries pathology, Humans, Multiple Trauma etiology, Multiple Trauma pathology, Amputation, Traumatic therapy, Blast Injuries therapy, Military Personnel, Multiple Trauma therapy
- Published
- 2016
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22. A Porcine Orthotopic Forelimb Vascularized Composite Allotransplantation Model: Technical Considerations and Translational Implications.
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Fries CA, Villamaria CY, Spencer JR, Rickard RF, Gorantla VS, and Davis MR
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- Animals, Animals, Inbred Strains, Bone Regeneration physiology, Graft Rejection pathology, Graft Rejection physiopathology, Graft Survival physiology, Haplotypes, Histocompatibility Testing, Swine, Tissue and Organ Harvesting methods, Weight-Bearing physiology, Forelimb transplantation, Translational Research, Biomedical, Vascularized Composite Allotransplantation methods
- Abstract
Background: The restoration of complex tissue deficits with vascularized composite allotransplantation is a paradigm shift in reconstructive surgery. Clinical adoption of vascularized composite allotransplantation is limited by the need for systemic immunosuppression, with associated morbidity and mortality. Small-animal models lack the biological fidelity and preclinical relevance to enable translation of immunologic insights to humans. Large-animal models have been described; however, limitations persist, including the inability of heterotopic models to evaluate functional nerve regeneration, and the sensitivity of primates to toxicity of immunosuppressive drugs. The authors' novel orthotopic porcine limb transplant model has broad applicability and translational relevance to both immunologic and functional outcomes after vascularized composite allotransplantation., Methods: Recipients underwent amputation at a level corresponding to the mid forearm. Replantation or transplantation of grafts was performed by plate fixation of the radio-ulna, microsurgical repair of brachial artery and median nerve, and extensor and flexor tendon repairs. Viability of replants was monitored clinically and radiologically. Transplants were monitored for clinicopathologic signs of rejection. Animals mobilized freely postoperatively., Results: Replantations remained viable until the endpoint of 14 days. Transplants developed Banff grade 4 acute rejection by postoperative day 7. Doppler sonography and angiography confirmed vascular patency. Serial biopsy specimens of skin and histopathology of replants at endpoint confirmed tissue viability and bone healing., Conclusions: An orthotopic load-bearing porcine forelimb vascularized composite allotransplantation model was successfully established. Technical, procedural, and logistic considerations were optimized to allow model use for immunologic, bone healing, functional nerve regeneration, and other translational studies.
- Published
- 2016
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23. Factors influencing infection in 10 years of battlefield open tibia fractures.
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Penn-Barwell JG, Bennett PM, Mortiboy DE, Fries CA, Groom AF, and Sargeant ID
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The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo-Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher's exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty's injuries was not associated with infection, the degree of bone loss from the fracture was.
- Published
- 2016
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24. High velocity gunshot injuries to the extremities: management on and off the battlefield.
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Penn-Barwell JG, Brown KV, and Fries CA
- Abstract
The gunshot wounds sustained on the battlefield caused by military ammunition can be different in nature to those usually encountered in the civilian setting. The main difference is that military ammunition has typically higher velocity with therefore greater kinetic energy and consequently potential to destroy tissue. The surgical priorities in the management of gunshot wounds are hemorrhage control, preventing infection, and reconstruction. The extent to which a gunshot wound needs to be surgically explored can be difficult to determine and depends on the likely amount of tissue destruction and the delay between wounding and initial surgical treatment. Factors associated with greater energy transfer, e.g., bullet fragmentation and bony fractures, are predictors of increased wound severity and therefore a requirement for more surgical exploration and likely debridement. Gunshot wounds should never be closed primarily; the full range of reconstruction from secondary intention to free tissue transfer may be required.
- Published
- 2015
- Full Text
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25. Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing.
- Author
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Fries CA, Ayalew Y, Penn-Barwell JG, Porter K, Jeffery SL, and Midwinter MJ
- Subjects
- Administration, Topical, Adult, Blast Injuries microbiology, Blast Injuries pathology, Debridement methods, Humans, Male, Prospective Studies, Soft Tissue Injuries microbiology, Soft Tissue Injuries pathology, Time Factors, Transportation of Patients, Treatment Outcome, Wound Healing, Wound Infection prevention & control, Wounds, Gunshot microbiology, Wounds, Gunshot pathology, Bandages, Blast Injuries therapy, Metal Nanoparticles therapeutic use, Military Personnel, Silver Compounds therapeutic use, Soft Tissue Injuries therapy, Wounds, Gunshot therapy
- Abstract
Introduction: Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings., Methods: Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score., Results: 76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p=0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p=0.5009, Mann-Whitney). Wounds in the control group were scored as being significantly more malodorous (p=0.002, Mann-Whitney) than those in the treatment arm., Conclusions: This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the critical determinant in wound healing and infection and this study did not demonstrate a benefit of nanocrystaline silver dressing in respect to preventing wound colonisation or promoting healing, these dressings do however seem to significantly reduce the unpleasant odour commonly associated with battlefield wounds., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
26. Hydrogen sulfide mitigates reperfusion injury in a porcine model of vascularized composite autotransplantation.
- Author
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Villamaria CY, Fries CA, Spencer JR, Roth M, and Davis MR
- Subjects
- Allografts blood supply, Allografts metabolism, Animals, Aspartate Aminotransferases blood, Biomarkers blood, Cytokines blood, Disease Models, Animal, Graft Survival, Hindlimb, Hydro-Lyases blood, Interleukin-6 blood, Random Allocation, Reperfusion Injury diagnosis, Reperfusion Injury metabolism, Swine, Transplantation, Autologous, Tumor Necrosis Factor-alpha blood, Allografts drug effects, Hydrogen Sulfide pharmacology, Myocutaneous Flap blood supply, Reperfusion Injury prevention & control
- Abstract
Background: Devastating extremity injuries are prevalent but often survivable on the modern battlefield. These complex injuries require advanced methods of reconstruction, involving prolonged ischemic periods and reperfusion injury. Using our group's validated porcine model of gracilis myocutaneous flap transplantation, this study demonstrates that an interim perfusion of hydrogen sulfide (H2S) mitigates the effects of reperfusion injury in the setting of delayed restoration of blood flow., Methods: A gracilis myocutaneous flap (200-400 g; surface area, 250 cm²) was procured from the hind limb of a Yorkshire swine (70-90 kg, n=16). The right external carotid artery and the internal jugular vein are the recipient axis. Group 1 (control, n = 6) underwent delayed anastomosis with a 3-hour ischemic period. Group 2 (n=10) underwent a similar delayed anastomosis with an interim perfusion of H2S during the ischemic period. The animals survived for 14 days. Systemic biomarker assays for skeletal muscle tissue injury (creatine kinase, lactate dehydrogenase, and aspartate transaminase) and proinflammatory markers (tumor necrosis factor α and interleukin 6) provide assessment of reperfusion injury at the cellular level., Results: The control animals (3 hours of ischemia with an interim perfusion of heparinized saline) demonstrated increased levels of injury biomarkers and proinflammatory cytokines compared with the animals receiving H2S infusion and identical ischemic interval. The control flaps had a mean creatine kinase level of 280³×10 U/L (±80×10³), compared with the H2S group, which had a mean of 99×10³ U/L (±14×10³; P=0.0007 at postoperative day 2). lactate dehydrogenase levels (mean) were 26×10³ U/L (±8×10³) versus 9×10³ U/L (±3×10³; P=0.0004) and aspartate transaminase levels (mean) were 1651 U/L (±324) versus (873 U/L [±279]; P=0.0013) for the control and treatment groups, respectively. Similarly, an intergroup difference in IL-6 was found, although not statistically significant. Tumor necrosis factor α levels (mean) were 93 pg/mL (±14) versus 39 pg/mL (±4; P=0.0013) for the control and treatment groups, respectively., Conclusions: This study demonstrated the mitigating properties of H2S on reperfusion injury. Interim perfusion with H2S resulted in diminution of ischemia-dependent biomarkers after 3 hours of ischemia. Follow-up studies will translate these findings as an evolving method for reconstructing previously unreconstructable injuries.
- Published
- 2014
- Full Text
- View/download PDF
27. Mortality, survival and residual injury burden of Royal Navy and Royal Marine combat casualties sustained in 11-years of operations in Iraq and Afghanistan.
- Author
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Penn-Barwell J, Fries CA, Bennett PM, Midwinter MJ, and Baker A
- Subjects
- Extremities injuries, Humans, Injury Severity Score, United Kingdom epidemiology, Wounds and Injuries mortality, Afghan Campaign 2001-, Cost of Illness, Iraq War, 2003-2011, Military Personnel statistics & numerical data, Wounds and Injuries epidemiology
- Abstract
We present eleven years of prospectively-gathered data defining the full spectrum of the United Kingdom's (UK) Naval Service (Royal Navy and Royal Marines) casualties, and characterise the injury patterns, recovery and residual functional burden from the conflicts of the last decade. The UK Military Trauma Registry was searched for all Naval Service personnel injured between March 2003 and April 2013. These records were then cross-referenced with the records of the Naval Service Medical Board of Survey (NSMBOS), which evaluates injured Naval Service personnel for medical discharge, continued service in a reduced capacity or Return to Full Duty (RTD). Population at risk data was calculated from service records. There were 277 casualties in the study period: 63 (23%) of these were fatalities. Of the 214 survivors, 63 or 29% (23% of total) were medically discharged; 24 or 11% (9% of total) were placed in a reduced fitness category with medical restrictions placed on their continued military service. A total of 127 individuals (46% of the total and 59% of survivors) RTD without any restriction. The greatest number of casualties was sustained in 2007. There was a 3% casualty risk per year of operational service for Naval Service personnel. The most common reason cited by Naval Service Medical Board of Survey (NSMBOS) for medical downgrading or discharge was injury to the lower limb, with upper limb trauma the next most frequent. This study characterises the spectrum of injuries sustained by the Naval Service during recent conflicts with a very high rate of follow-up. Extremity injuries pose the biggest challenge to reconstructive and rehabilitative services striving to maximise the functional outcomes of injured service personnel.
- Published
- 2014
28. The injury burden of recent combat operations: mortality, morbidity, and return to service of U.K. naval service personnel following combat trauma.
- Author
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Penn-Barwell JG, Fries CA, Bennett PM, Midwinter M, and Baker AB
- Subjects
- Adult, Female, Humans, Injury Severity Score, Male, Morbidity trends, Prognosis, Retrospective Studies, Survival Rate trends, United Kingdom epidemiology, Warfare, Wounds and Injuries diagnosis, Wounds and Injuries rehabilitation, Military Medicine methods, Military Personnel, Motor Activity physiology, Recovery of Function, Registries, Wounds and Injuries epidemiology
- Abstract
Objectives: The study establishes the functional outcomes of service personnel injured in current conflicts by correlating data on initial injury to the findings of medical boards after trauma and reconstructive treatment. Data comprehensively include all casualties of the Royal Navy and Royal Marines and all functional outcomes., Methods: Details of all casualties from 2003 to 2010 taken from the Joint Theatre Trauma Registry and records of all medical boards relating to these personnel were analysed. Population at risk and probability of survival data were calculated., Results: There were 221 casualties: 54 (24%) were fatalities; of 167 survivors, 21 (9% of total) were medically discharged; 26 (12%) were placed in reduced fitness category and 120 (55%) returned to full duty. Casualty risk per year of operational service for Naval Service personnel was 4.6%. New injury severity score and functional outcome were closely correlated, with specific exceptions. There were 3 unexpected survivors and no unexpected fatalities. Extremity injuries predominate in survivors., Conclusions: The Defence Medical Service (DMS) provides excellent trauma and rehabilitative care. The authors contend that this is a valid proxy for other larger coalition formations. Specific injury patterns have higher impact on functional outcomes; future research efforts should focus on these areas., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)
- Published
- 2013
- Full Text
- View/download PDF
29. Battlefield scrotal trauma: how should it be managed in a deployed military hospital?
- Author
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Williams RJ, Fries CA, Midwinter M, and Lambert AW
- Subjects
- Afghanistan, Blast Injuries etiology, Debridement methods, Hospitals, Military, Humans, Male, Orchiectomy, Scrotum surgery, Warfare, Wounds, Penetrating, Blast Injuries surgery, Military Medicine methods, Scrotum injuries
- Abstract
Aim: There is little documented advice on the management of scrotal trauma sustained in combat. This paper reviews this injury, its present surgical management and makes recommendations for the future., Method: All UK forces sustaining scrotal injuries between 2003 and 2009, in Iraq and Afghanistan, initially treated at a Role 2 (enhanced) or Role 3 deployed military surgical facility were identified from the Joint Theatre Trauma Registry. The cause and extent of the injury, in addition to the surgical management, are reported., Results: Twenty-seven patients sustained trauma to their scrotum; improvised explosive device (IED) (n=21), mine (n=3), rocket propeller grenade (RPG) (n=2), mortar round (n=1). Of those injured by an IED, eleven had traumatic orchidectomies, of which 4 were bilateral, one received fragmentation wounds to the scrotum with a testicular injury that was salvaged and there were six scrotal fragmentation wounds not associated with a testicular injury. Scrotal exploration was performed with testicular salvage in all cases involving mortar, RPG or mines. For all aetiologies the scrotum was debrided with primary closure over a drain (n=7), debridement and subsequent delayed primary closure (DPC) (n=4) or healing by secondary intension (n=6). Skin grafts were applied in two cases of traumatic bilateral orchidectomy. To date there have been two cases of delayed orchidectomy; chronic pain and delayed presentation of a disrupted testis. All reported patients survived., Conclusion: The established principles of debridement should be the mainstay of treatment. Testicular ischaemia, a consequence of cord transaction, necessitates orchidectomy. Salvage of the disrupted testis, with debridement and closure of the tunica rather than orchidectomy, should be performed whenever possible, particularly when there is significant bilateral testicular injury. Scrotal wounds can be treated by closure over a drain, DPC or healing by secondary intention., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2013
- Full Text
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30. Severe open tibial fractures in combat trauma: management and preliminary outcomes.
- Author
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Penn-Barwell JG, Bennett PM, Fries CA, Kendrew JM, Midwinter MJ, and Rickard RF
- Subjects
- Adult, Follow-Up Studies, Fractures, Open etiology, Humans, Injury Severity Score, Registries, Surgical Wound Infection epidemiology, Tibial Fractures etiology, Treatment Outcome, United Kingdom, Wound Healing, Fracture Fixation, Internal methods, Fracture Fixation, Internal statistics & numerical data, Fractures, Open surgery, Plastic Surgery Procedures methods, Plastic Surgery Procedures statistics & numerical data, Tibial Fractures surgery, Warfare
- Abstract
The aim of this study was to report the pattern of severe open diaphyseal tibial fractures sustained by military personnel, and their orthopaedic-plastic surgical management.The United Kingdom Military Trauma Registry was searched for all such fractures sustained between 2006 and 2010. Data were gathered on demographics, injury, management and preliminary outcome, with 49 patients with 57 severe open tibial fractures identified for in-depth study. The median total number of orthopaedic and plastic surgical procedures per limb was three (2 to 8). Follow-up for 12 months was complete in 52 tibiae (91%), and half the fractures (n = 26) either had united or in the opinion of the treating surgeon were progressing towards union. The relationship between healing without further intervention was examined for multiple variables. Neither the New Injury Severity Score, the method of internal fixation, the requirement for vascularised soft-tissue cover nor the degree of bone loss was associated with poor bony healing. Infection occurred in 12 of 52 tibiae (23%) and was associated with poor bony healing (p = 0.008). This series characterises the complex orthopaedic-plastic surgical management of severe open tibial fractures sustained in combat and defines the importance of aggressive prevention of infection.
- Published
- 2013
- Full Text
- View/download PDF
31. Management of intestinal injury in deployed UK hospitals.
- Author
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Fries CA, Penn-Barwell J, Tai NR, Hodgetts TJ, Midwinter MJ, and Bowley DM
- Subjects
- Adolescent, Adult, Hospitals, Military, Humans, Iraq War, 2003-2011, Military Medicine, United Kingdom, Wounds, Penetrating surgery, Young Adult, Abdominal Injuries surgery, Afghan Campaign 2001-, Blast Injuries surgery, Intestines injuries, Laparotomy, Military Personnel, Wounds, Gunshot surgery
- Abstract
Introduction: Definitive laparotomy (DL), with completion of all surgical tasks at first laparotomy has traditionally been the basis of surgical care of severe abdominal trauma. Damage control surgery (DCS) with a goal of physiological normalisation achieved with termination of operation before completion of anatomical reconstruction, has recently found favour in management of civilian trauma. This study aims to characterise the contemporary UK military surgeon's approach to abdominal injury., Patients and Methods: A retrospective analysis was performed on British service personnel who underwent a laparotomy for intestinal injury at UK forward hospitals from November 2003 to March 2008 as identified from the Joint Theatre Trauma Registry. Patient demographics, mechanism and pattern of injury and clinical outcomes were recorded. Surgical procedures at first and subsequent laparotomy were evaluated by an expert panel., Results: 22 patients with intestinal injury underwent laparotomy and survived to be repatriated; all patients subsequently survived to hospital discharge. Mechanism of injury was GSW in seven and blast in 13. At primary laparotomy, as defined by the operating surgeon, 15/22 underwent DL and 7/22 underwent DCS. Mean Injury Severity Score (ISS) was 19 for DL patients compared to 29 for DCS patients (p = 0.021). Of the 15 patients undergoing DL nine had primary repair (suture or resection/ anastomosis), one of which subsequently leaked. Unplanned re-look was required in 4/15 of the DL cases., Conclusion: This review examines the activity of British military surgeons over a time period where damage control laparotomy has been introduced into regular practice. It is performed at a ratio of approximately 1:2 to DL and appears to be reserved, in accordance with military surgical doctrine, for the more severely injured patients. There is a high rate of unplanned relook procedures for DL suggesting DCS may still be underused by military surgeons. Optimal methods of selection and implementation of DCS after battle injury to the abdomen remain unclear.
- Published
- 2011
- Full Text
- View/download PDF
32. Topical negative pressure and military wounds--a review of the evidence.
- Author
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Fries CA, Jeffery SL, and Kay AR
- Subjects
- Evidence-Based Practice, Humans, Practice Guidelines as Topic, Wound Healing, Wounds and Injuries classification, Military Medicine methods, Negative-Pressure Wound Therapy methods, Wounds and Injuries therapy
- Abstract
Background: Topical negative pressure (TNP) has been used as a method of wound management for some years. Use of TNP is accepted best practice at Role 4. There are advocates of using TNP after initial wound surgery at Role 3 or 2E. The evidence to support forward use of TNP is not comprehensive, especially when considering this narrow cohort of patients and injury pattern. It is the aim of this review to evaluate the current evidence for the use of TNP in all wounds, and to find what evidence there is that may be applicable to military wounds., Methods: A literature search of Cinahl, Embase, Medline, ProQuest and the Cochrane Library was conducted; references were cross-referenced. All Randomised Controlled Trials (RCTs) were included in all languages over a comprehensive time period. An interim review was conducted by the Wound Management Working Group of the Academic Department of Military Surgery and Trauma. A further literature review was conducted to find all papers relating to the use of TNP on military wounds., Results: 17 reports were reviewed relating to 14 studies including 662 patients. Of these 131 were reported to have had traumatic injuries. Significant results were reported with respect to time to wound healing, patient comfort and reduction in wound volumes. Bacterial load was not affected, in the 3 trials which commented on this, but in 1 there was a significant reduction in wound infections in the TNP group. Several of the trials were small, methodology was not consistent therefore no meta-analysis was possible. 2 papers were found describing case series of military patients being treated with TNP., Conclusions: There is very little published evidence in the form of RCTs to support the use of TNP in the acute traumatic military setting. This review supports the requirement for further investigation to evaluate whether this method of wound management has a place forward of Role 4., (2010 Elsevier Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
33. Use of topical negative pressure in british servicemen with combat wounds.
- Author
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Penn-Barwell JG, Fries CA, Street L, and Jeffery S
- Abstract
Objective: The objective of this study was to characterize the use of topical negative pressure therapy in combat wounds., Methods: This study was a retrospective review of the records of patients whose wounds were managed with topical negative pressure between April 2007 and March 2008. The main outcome measure was episodes of antibiotic prescription, which was used as a surrogate marker of clinically relevant infection., Results: Of the 62 cases identified, 25 clinical notes were unavailable and were excluded from the study leaving 37 included cases. All but one of the cases was male with an average age of 29 (19-39) and New Injury Severity Score (NISS) of 21.3 (14.4-28.1). In 20 cases, topical negative pressure was changed less than once per 4.9 days on average, and in the remaining 17 cases, this was done more frequently. Comparison of the rate of antibiotic prescription between these groups reveals a significantly higher rate in the cohort managed with more frequent topical negative pressure changes. However this relationship was not borne out in a multiple variable analysis., Conclusion: This study describes the use of topical negative pressure in the management of a uniquely challenging group of patients. Statistical analysis of relatively small numbers is challenging but these results support the current complex wound management strategies where wounds are temporized with topical negative pressure for several days following thorough wound debridement. This period allows patients to be physiologically stabilized, other injuries to be addressed and appears not to be associated with increased infections.
- Published
- 2011
34. The team works--a multidisciplinary challenge.
- Author
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Fries CA, Midwinter MJ, Bree SE, Taylor PJ, and Peterson M
- Subjects
- Afghanistan, Blast Injuries surgery, Child, Preschool, Female, Humans, Thoracic Injuries surgery, Hospitals, Military, Naval Medicine, Patient Care Team organization & administration
- Published
- 2007
35. A thorn in the side.
- Author
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Fries CA and Campbell JK
- Subjects
- Adult, Afghanistan, Humans, Male, Pneumothorax etiology, Radiography, Military Medicine, Pneumothorax diagnostic imaging, Wounds, Gunshot complications
- Abstract
This case demonstrates the importance of a thorough secondary survey in the management of ballistic injury. It also illustrates the need for systematic use of radiology, and the early management of life threatening conditions--regardless of whether their cause is known.
- Published
- 2006
36. Fat supplementation influences postpartum reproductive performance in Brahman cows.
- Author
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De Fries CA, Neuendorff DA, and Randel RD
- Subjects
- Animals, Body Weight, Energy Intake, Estrus physiology, Female, Food, Fortified, Male, Oryza, Ovarian Follicle cytology, Parity, Pregnancy, Weight Gain, Animal Feed, Dietary Fats, Postpartum Period physiology, Pregnancy, Animal physiology, Reproduction physiology
- Abstract
Multiparous Brahman cows (n = 40) in excellent body condition (6.5+/-.1) were randomly assigned to receive either 5.2 (rice bran) or 3.7% (control) dietary fat after calving. The experimental diets were formulated to be isocaloric and isonitrogenous. The experimental diets were fed twice daily from d 1 after calving through the first normal estrous cycle. Cows were weighed, scored for body condition, and bled at weekly intervals from d 1 through 50 after calving. Weekly bleedings continued until the first detectable estrus. Blood samples were collected daily throughout the first normal estrous cycle. All cows were exposed to a fertile bull at the estrus following the first normal estrous cycle and for a 60-d breeding season. Ovarian follicular populations were recorded weekly by transrectal ultrasonography from d 15 to 50 after calving. Calf weights were recorded at 14-d intervals from d 1 to 43 after birth and at weaning (205 d). Cows receiving rice bran gained more body condition (P < .05) than cows receiving the control supplement. The numbers of small (< 4.0 mm, P < .05), medium (4.0 to 7.9 mm, P < .05) and total follicles (P < .05) were greater in the rice bran than in the control group from 15 to 29 d after calving, and large follicles ( > or = 8.0 mm) increased in number (P < .05) and the largest follicle increased in size (P < .001) over time regardless of the level of dietary fat. Fat supplementation increased the numbers of medium (P < .01), large (P < .05), and total (P < .01) follicles and size of the largest follicle (P < .05) during the 3 wk before the first normal estrous cycle. The intervals from parturition to reproductively important end points were similar (P > .10) between dietary treatments as well as the percentage of cows showing normal or abnormal estrous cyclic activity. Treatment did not affect (P > .10) daily serum progesterone (P4) concentrations. However, there was a tendency (P = .09) for more rice bran-supplemented cows to be pregnant (94.1 vs 71.4%) after being exposed to a fertile bull for 60 d. Calf weight gain tended to be higher (P = .08) in calves nursing rice bran-supplemented dams. In conclusion, using rice bran, with high concentrations of oleic and linoleic acids, as a fat supplement for postpartum cows enhanced ovarian follicular growth before normal estrous cycles resumed and increased body condition scores and pregnancy rates without altering postpartum interval or serum P4 concentrations.
- Published
- 1998
- Full Text
- View/download PDF
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