Elaboración de un simulador de trauma torácico a partir de un torso cadavérico utilizando tecnología de imágenes digitales e impresión 3D / Elaboration of a thoracic trauma surgery simulation model from a cadaveric human torso incorporating digital image technology and 3D printing

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Self-confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons / Autoconfiança nas habilidades cirúrgicas adquiridas para lidar com pacientes com trauma grave em cirurgiões recém-formados

ABSTRACT Background: Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.

RESUMO Racional: Trauma é uma das principais causas de morte no mundo e cuidados cirúrgicos adequados são críticos para determinar a mortalidade. No Chile, morte associada a trauma é a primeira causa de mortalidade na população entre 20 e 59 anos. Para lidar com esses pacientes complexos, são necessárias habilidades cirúrgicas precisas para esses procedimentos. Autoconfiança de cirurgiões recentemente graduados na Residência em Cirurgia Geral para práticas de procedimentos de trauma no nosso país não tem sido reportada. Objetivo: Descrever nível de autoconfiança para lidar com procedimentos de trauma em cirurgiões recentemente graduados na residência de cirurgia geral. Método: Estudo transversal. Foi desenhada e aplicada uma enquete em 2015, 2016 e 2017 a cirurgiões recentemente graduados para pesquisar sobre autoconfiança e habilidades cirúrgicas para lidar com cenários de trauma. Foram avaliados 18 procedimentos cirúrgicos de trauma (incluindo procedimentos cervicais, torácicos, abdominais e vasculares) usando a 5-grade Likert Scale. O número total de procedimentos feitos durante a residência foi avaliado. Resultados: Foram incluídos 88 cirurgiões recentemente graduados. O nível de competência foi reportado como alto em procedimentos como trauma intestinal, onde 98% sentiu-se competente ou muito competente em sua reparação. Por outro lado, em traumas complexos como dano vascular maior, até 76% reportaram não se sentirem competentes. A autoconfiança nos procedimentos esteve diretamente associada com o número de procedimentos realizados. Conclusões: Cirurgiões recentemente graduados na residência de cirurgia geral reportam níveis altos de confiança para lidar com traumas de complexidade baixa e média, mas um nível menor de confiança para tratar casos de complexidade alta.

Atención de los pacientes con trauma grave durante los primeros días: evolución entre la urgencia, el pabellón y la unidad de cuidados intensivos / Features of patients with trauma admitted to an emergency room of a general hospital

Background: Trauma is the main cause of death among people aged 5 to 44 years. Aim: To describe features, treatment and evolution of trauma patients admitted to an emergency room. Material and Methods: Adult patients admitted in the emergency department of a public hospital due to severe trauma were studied and followed during their hospital stay. Results: We included 114 patients aged 40 ± 17 years (78%men) with an injury severity score of 21 ± 11. Trauma was penetrating in 43%. Traumatic brain injury (TBI) was the most common diagnosis in 46%. In the emergency room, 8% had hypotension, 5% required vasopressors and 23% required mechanical ventilation. The initial lactate was 3.6 ± 2.9 mmol/L. Sixty-five patients (57%) required emergency surgery. The intraoperative lactate was 3 ± 1.7 mmol/L and 20% required vasopressors. Sixty-four patients (56%) were admitted to the ICU, with APACHEII and SOFA scores of 16 ± 8 and 5 ± 3, respectively. ICU lactate was 3.2±1.5 mmol/L. In the ICU 40% required vasopressors and 63% mechanical ventilation. Thirty two percent had coagulopathy, 43% received transfusions and 10% required massive transfusions. The hospital stay was 13 (6-32) days, being significantly longer in patients with TBI. ICU and hospital mortalities were 12.5 and 18.4% respectively. The only predictor for mortality was the APACHEII score (Hazard Ratio 1.18, 95% confidence intervals 1.03-1.36). Conclusions: APACHE score was a predictor of mortality in this group of patients.

Tumor fibroso solitario y síndrome Doege-Potter / Solitary fibrous tumor and Doege-Potter syndrome

El tumor fibroso solitario es raro. Si bien su localización más frecuente es la pleura, han sido informados algunos casos de ubicación retroperitoneal. Es difícil diferenciarlo imagenológicamente de otras neoplasias, por lo que casi siempre el diagnóstico es histológico. Dado que los tumores fibrosos solitarios tienen presentaciones clínicas muy diversas, una mejor compresión de la ubicación y sus características imagenológicas ayudaría a abreviar la lista de diagnósticos diferenciales. Comunicamos un tumor fibroso solitario de localización retroperitoneal cuyo diagnóstico fue confirmado por examen histológico.

The solitary fibrous tumor is uncommon. Even though it frequently locates in the pleura, a few cases have been reported in the retroperitoneum. Differentiation from other neoplasms is difficult, and therefore the diagnosis is always attained through histological examination. Although solitary fibrous tumors have variable clinical behaviors, a better comprehension of the location and its imaging characteristics would help to decrease the list of differential diagnoses. We report a solitary fibrous tumor located in the retroperitoneum whose diagnosis was confirmed by histological examination.