Intra-abdominal volume increment is a new abdominal surgery, which is used to prevent the abdominal compartment syndrome caused by intra-abdominal hypertension.In this article, the author emphasizes the concept, indications,operative principles of intra-abdominal volume increment. Firstly,laparotomy was performed, active bleeding and source of infection were controlled. Then greater omentum was put under the incision, vacuseal dressings were apphed on the greater omentum,and the abdominal incision was sutured. If the intra-abdominal pressure was less than 12 mm Hg (1 mm Hg=0. 133 kPa) for 48 hours during 7-14 days after operation, abdominal incision could be closed, while if the intra-abdominal pressure was more than 12 mm Hg, dermatoplasty was used to close abdominal incision to form a ventral hernia, then definitive abdominal wall reconstruction was performed 6 months after operation.

Reducing the misdiagnosis rate and negative exploratory rate is still a challenge in the diagnosis and treatment process for abdominal trauma.In this article,the diagnosis and treatment are processed based on the hemodynamic and injury mechanism,and the injury evaluation techniques including physical examination,focused abdominal sonography for trauma,computed tomography,diagnostic peritoneal lavage and urgent treatment strategies for blunt trauma and penetrating trauma,as well as the exploratory techniques in the laparoscopy and laparotomy are introduced.

The general experiences of medical support in Wenchuan earthquake have been summarized based on the investigation in the earthquake-hit areas and the analysis of correlated literature.The main experiences include: medical support by the local hospitals of earthquake-hit areas was essential;medical aid should be conducted in three echelons;multi-disciplinal coordination and cooperation in care of injuries;integration of rescue teams from other provinces or countries by different channels;and important role played by armed forces.There is room for improvement in the emergency rescue and medical service.The key points to improve the rescue level of natural disaster

Objective To create a stable,reliable and cheap rat model of intra-abdominal hypertension(IAH)by simulating the development of secondary IAH after overdose resuscitation for severe hemorrhagic shock.Methods Sixteen adult male SD rats were randomly divided into sham group and portal vein stenosis group,with eight rats in each group.Portal vein stenosis group had transabdominal separation of portal vein with constant stenosis,while sham group underwent simple laparotomy and dissection of portal vein.Abdominal binding and hemorrhagic shock by drawing blood through the femoral artery cannulation with mean arterial pressure(MAP)of 40 mm Hg(1 mm Hg=0.133 kPa)for two hours were performed in two groups.Then,reinfusion of all autologous blood and continuous infusion of sodium lactate Ringer's solution were performed to induce IAH.Results In the portal vein stenosis group,IAH models were successfully built in all the rats except that one rat died after ligation of portal vein.The success rate of modeling was 87.5％,with total time of(4.68±0.53)hours and total solution infusion of(597.33±75.03)ml/kg.No successful modeling was obtained in the sham group.Conclusion High success rate and good reproducibility of IAH models can be achieved by fluid resuscitation after constant portal vein stenosis,abdominal binding and hemorrhagic shock with mean MAP of 40 mm Hg for two hours.

Abdominal increment is applied to patients with abdominal compartment syndrome (ACS) after severe trauma,while for some patients,intra-abdominal volume increment could not close the fascia within the primary stage.For theses patients,abdominal wound skin grafting was conducted,and the planned hernia was formed.Planned abdominal hernia developed over time,and finally huge incisional hernia was formed.This article described a modified sliding myofascial flap of the rectus abdominus muscles for definitive abdominal wall reconstruction for a patient with huge planned abdominal hernia,and a good curative effect was obtained.

Objective To investigate the significance of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypovolemic shock in severe traumatic patients.Methods Clinical and spiral CT image data of 63 patients with severe trauma treated between January 2008 and December 2011 were reviewed retrospectively.According to the occurrence of shock at 24 hours after spiral CT scan,the patients were divided into shock group (34 cases) and stable group (29 cases).Blood pressure,heart rate,ISS,blood pH value,blood lactate (Lac),and buffer excess (BE) and other indices on admission were analyzed and compared between the two groups.Diameter of abdominal great vessels including aorta,inferior vena cava,superior mesenteric artery and superior mesenteric vein were measured on enhanced spiral CT images as well as their CT values in both early and delayed phase of enhancement.Results The shock group showed significantly higher ISS and blood Lac level,but significantly lower BE as compared with the stable group (P ＜ 0.05).Inferior vena cava in the shock group presented signs of deformity and collapse.Minimal diameters of the four abdominal levels were all shorter in the shock group than in the stable group (P ＜0.01).In the early enhancement on spiral CT,the CT value of superior mesenteric artery was lower in the shock group than in stable group [(133.2 ± 32.4) HU vs (186.3 ± 23.3) HU,(P ＜ 0.05)],while the CT value of inferior vena cava above the upper edge of the liver was significantly higher in shock group than in stable group [(133.4 ± 20.3) HU vs (112.0 ± 21.9) HU,(P ＜ 0.01)].In the delayed enhancement on spiral CT,the CT value of each vessel presented no statistical differences between the two groups.Conclusion Some hypo-perfusion signs of abdominal vessels on enhanced CT have some reference value on the early diagnosis of hypovolemic shock in severe traumatic patients.

With the widely use of tourniquet in battlefield, the mortality of limbs bleeding has decreased remarkably. However, torso hemorrhage has become the leading cause inducing battlefield mortality. In present paper, the concept and features of torso hemorrhage were introduced, and the scheme, equipment and techniques of emergency control of torso hemorrhage were also described systematically, including local hemostatic materials, cavity foam materials, hemostasis device and aortic compression technique, etc. At the present stage, it is the key of reducing tactics mortality to actively research and develop the tactical stage equipment and technology for emergency treatment of tactical torso injuries. We should draw lessons from foreign army and positively face the severe challenges on torso trauma to enhance our ability in tactical trauma care.

Objectives:To investigate the effects of early enteral feeding(EEF) after hemorrhagic shock(HS) on gut structure and function,hormones for stress and metabolism and nutritional conditions. Methods:Seventy two Wistar rats were randomly divided into sham shock group(SS),HS group(HS) and post HS EEF gorup(HSE).HSE group was fed with ENSURE and HS group was fed with normal saline.EEF was started within 1 hour after resuscitation.The body weight,liver weight,musculus gastrocnemius weight,nitrogen content in liver and musculus gastrocnemius,total plasma protein level,albumin level,MDA(malondialdehyde) and Na + K + ATPase activity in stomach and jejunum mucosa, the change of liver function, the levels of glucagon,cortisol and insulin,and the pathological changes in stomach, small intestine and liver were investigated at 2,6,24,48 h after resuscitation. Results:When compared with HS group,the weight of body,liver and musculus gastrocnemius,the nitrogen content in liver and musculus gastrocnemius,the levels of total plasma protein and albumin and the liver function were significantly better in the HSE group.MDA content was less and Na + K + ATPase activity was higher in HSE group than those in HS group.The glucagon and cortisol levels were significantly lower and the insulin level was significantly higher in HSE group than those in HS group.The pathological changes in the stomach,intestine and liver in HSE group got an obvious improvement. Conclusions:After HS,EEF is helpful to maintain visceral organ function,reduce the stress and hypermetabolic response and improve the nutritional conditions.

Hemorrhagic shock and lethal massive hemorrhage are leading causes of death in both combat and civilian trauma casualties, accounting for more than 80% of deaths in operating rooms and 70% of deaths within 24 hours after trauma. Management of such patients is the main challenge and core competence in establishment of a trauma center. Damage-control resuscitation measures in pre-hospital settings include following ABCs rules, implementing appropriate transfusion and infusion strategies based on pre-hospital transport time, maintaining blood pressure based on a specific injury, and using tranexamic acid. The core of damage-controlled resuscitation in in-hospital settings is early correction of traumatic coagulopathy by massive transfusion. Damage-control surgery in pre-hospital settings consists mainly in cervical spine protection, pelvic band fixation, thoracic drainage, direct compression hemostasis, etc. Resuscitation aortic balloon occlusion for non-compression lethal hemorrhage is the most promising life-saving means. Damage-control surgery in in-hospital settings includes damage control laparotomy, thoracotomy, orthopedic surgery and craniotomy. Only a combination of damage-control surgery and damage-controlled resuscitation in prime time can ultimately save patients with such severe trauma.

Objective To investigate the effect of damage control laparotomy in multiple trauma care.Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015.Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years).The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case.Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points).All cases presented abdominal injury.Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases.All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery.Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation.Results Twenty-nine cases had primary fascial closure 5-12 d after surgery.Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia.Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD).Hospital length of stay was 21-70 d (mean, 31.4 d).There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment.Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage.All cases were discharged from hospital smoothly.Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury.