Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review / 中华创伤杂志(英文版)

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

Cell cycle characteristics of the pancreas in an animal model of isolated pancreatic trauma.

BACKGROUND: In our previous study, we established a small animal model that mimicked the pathophysiology of isolated pancreatic trauma. To gain further insights into the relationships between tissue damage and the ability of the pancreatic cells to regenerate, we induced pancreatic trauma in rats maintained over 7 days and analyzed both the alteration of the cell death and the cell cycle distribution of the pancreatic cells in this study. METHODS: The rats were divided into two groups as follows: impact and control. The pancreas in the impact group was injured by a BIM-III biotical impact machine. Pancreatic enzyme activity, the level of Ca in the serum, pancreatic cell death, and cell cycle characteristics were examined after the trauma. RESULTS: In the impact groups, lipase was activated later than amylase and lasted persistently. The levels of serum Ca decreased at 6 hours after injury, sharply declined at 24 hours and 72 hours compared with the control groups, and returned to normal levels at 7 days. The pancreatic trauma also induced the compensatory proliferation of pancreatic cells. The results from a TUNEL stain, flow cytometry, Western blot, and immunohistochemistry indicated that pancreatic trauma induces cell death and the compensatory proliferation of pancreatic cells. CONCLUSION: Detecting amylase and lipase at the same time can help us determine the exocrine function of pancreas. Serum Ca can be used as an indicator for estimating the severity of pancreatic trauma. The cell cycle characteristics of the pancreas in the animal model of isolated pancreatic trauma indicate that the proper remedial time is in the first 24 hours after the pancreatic trauma.