Reconstructing The War injured Patient

Description

This text provides a comprehensive and state-of-the art approach to reconstruction of the war injured patient tailored to the types of injuries and patients mostly encountered from the Arab region over the past few years at the American University of Beirut Medical Center, one of the largest tertiary care and referral centers in the area and its affiliated hospitals. The book discusses in detail evidence of literature, new research data and new perspectives about the management and reconstruction of all types of injuries: ophthalmic, head and neck, upper and lower limb bone and soft tissue trauma, trunk, visceral and urogenital injuries as well as vascular and central and peripheral nerve injuries. It also highlights the social burden of these injuries as well as the importance of rehabilitation and psychological support for the war injured. The most recent findings of the change in the microbiology of these wounds and their treatment modifications are also discussed. Reconstructing the War Injured Patient will serve as a valuable resource for surgeons, clinicians and researchers dealing with and interested in the multiple facets of current war casualty care all the way from the battlefields to the long-term chronic rehabilitation. It includes concise yet comprehensive overviews of the current status of the war casualty patient reconstruction domain. It will help guide patient management based on evidence from literature, clinical and surgical experience and ongoing research. It will also help stimulate investigative efforts in this dynamic and active field of war medicine.

Table of Contents

1. Contributors
2. 1: Ballistics of Gunshot Wounds
3. Introduction
4. Ballistics of Bullets and Projectiles
5. Characteristics of Firearms
6. The Barrel
7. Rifling
8. Low- Versus High-Velocity/Energy Firearms
9. Characteristics of Bullets
10. Caliber
11. Nose Profile/Contour
12. Composition
13. Shell/Jacket
14. Construction
15. From Barrel to Target: How the Bullet Travels
16. Yaw
17. Spin
18. Precession
19. Nutation
20. Energy Transfer in Gunshot Wounds
21. The Fallacy of Equating Wound Severity with Velocity
22. Mechanism of Gunshot Wounds
23. Direct Tissue Damage
24. Cavitation
25. Bone Injuries
26. Head Injuries
27. Contamination
28. References
29. 2: Biodynamics of Blast Injuries
30. Introduction
31. Blast Physics
32. Mechanisms of Blast Injuries
33. Primary Blast Injuries (PBI)
34. Biological Effects of Primary Blast Injuries
35. Pulmonary System
36. Gastrointestinal System
37. The Ear
38. Conclusion
39. References
40. 3: Management of Craniomaxillofacial Injuries
41. Introduction
42. Immediate Nonoperative Management
43. Airway
44. Bleeding
45. Physical Exam and Diagnosis
46. Antibiotic Therapy
47. Operative Management
48. Wound Preparation and Tissue Coverage
49. Mandibular Fractures
50. Maxillary and Frontal Sinus Fractures
51. Facial Nerve Injury
52. Naso-Orbital-Ethmoid Region (NOE)
53. Nasal Region
54. Management of the Complicated Wound
55. Management in the Chronic Phase
56. Scar Contractures
57. Facial Tattooing
58. Flap Refinements
59. Soft-Tissue Depressions
60. Nasal Refinements
61. Residual Palatal Defects
62. Ocular Prosthesis
63. Dentition
64. Perioral Trauma
65. Case Study
66. Case
67. Principles Reviewed
68. Conclusion
69. References
70. 4: The Management of Penetrating Neck Injuries
71. Introduction
72. Immediate Management
73. Management of Carotid Injuries
74. Open Repair
75. Endovascular Treatment
76. Blunt Neck and Carotid Injury
77. Summary
78. References
79. 5: Reconstruction of Periocular War Injuries
80. Case Presentations
81. Case 1
82. Case 2
83. Case 3
84. Case 4
85. Case 5
86. Case 6
87. Case 7
88. Case 8
89. References
90. 6: Management of the Upper Limb Soft-Tissue Injuries
91. Introduction
92. Management and Reconstructive Options
93. Soft-Tissue Reconstruction
94. Soft-Tissue Defects of the Fingers
95. Soft-Tissue Defect to the Thumb, Volar, and Dorsal Hand
96. Skeletal Reconstruction
97. Tendon Reconstruction
98. Nerve Reconstruction
99. Conclusion
100. Clinical Cases
101. Case 1
102. Case 2
103. Case 3
104. References
105. 7: Management of Brachial Plexus Injuries
106. Introduction
107. Management in the Intermediate Phase
108. Management in the Chronic Phase
109. Conclusion
110. References
111. 8: Management of Upper Limb Fractures
112. Introduction
113. Shoulder Girdle Injury
114. Humeral Diaphyseal Fracture
115. Shattered Elbow
116. Forearm Injury
117. Wrist Injury
118. References
119. 9: Lower Extremity Reconstruction
120. Introduction
121. General Principles
122. Timing of Reconstruction
123. Negative-Pressure Wound Therapy (NPWT)
124. Bone Defect
125. Reconstruction According to Anatomical Region
126. Knee Region
127. Proximal Third of the Leg
128. Middle Third of the Leg
129. Distal Third of the Leg, Ankle, and Foot
130. Free Tissue Transfer
131. Choice of Flap Tissues
132. General Principles
133. Perforator Propeller Flaps
134. Management of Inadequate BKA Stump
135. References
136. 10: Management of Peripheral Nerve Injuries
137. Introduction
138. Management in the Intermediate Phase
139. Management in the Chronic Phase
140. Conclusion
141. References
142. 11: Management of Lower Limb Fractures
143. Introduction
144. Management of Lower Limb Fractures in the Intermediate and Chronic Phase
145. Simple Bone Loss/Nonunion
146. Infected Nonunion
147. Articular Damage
148. Knee Joint
149. Ankle Joint
150. Reconstruction Post Revascularization Injury
151. Conclusion
152. References
153. 12: Abdominal Wall Reconstruction
154. Introduction
155. Challenges in Abdominal Wall Reconstruction
156. Immediate Temporary Closure
157. The Role of VAC Therapy
158. Delayed Temporary Closure
159. Stage 2: Abdominal Wall Reconstruction
160. Timing
161. Role of Mesh
162. Reconstructive Options
163. Component Separation
164. Tissue Expansion
165. Local and Regional Flaps
166. Free Flaps
167. References
168. 13: Contemporary Management of Urogenital Injuries
169. Renal Injuries
170. Urinary Extravasation
171. Delayed Hemorrhage
172. Renal Insufficiency
173. Urinary Fistulas
174. Hypertension
175. Follow-Up
176. Ureteral Injury
177. Bladder Injury
178. Injuries to the External Genitalia
179. Penile Injuries
180. Urethral Injuries
181. Scrotal and Testicular Injury
182. Case Study: Multi-injury of the External Genitalia in a Young Man
183. References
184. 14: Management of Central Nervous System War Injuries
185. War Brain Injury
186. Clinical Cases
187. Case 1
188. Case 2
189. War Injury to Spine
190. Clinical Cases
191. Case 3
192. Case 4 (Fig. 14.4)
193. References
194. 15: Vascular Trauma
195. Introduction
196. Established Principles in the Management of Vascular Trauma
197. References
198. 16: Early Microsurgical Management of Blast Injuries
199. Introduction
200. Ammunition and Ballistics
201. Radiological Investigations
202. General Principles of Surgical Management
203. Discussion
204. Conclusion
205. References
206. 17: Amputations and Prostheses
207. Introduction
208. Acute Phase of Management
209. Decision of Amputation and Scoring Systems
210. Level of Amputation
211. Transtibial Amputations
212. Surgical Technique
213. Intermediate Phase of Management
214. Uncomplicated Amputations
215. Wound Care
216. Stump Closure
217. Complicated Amputations
218. Hemorrhage
219. Infection
220. Wound Dehiscence
221. Chronic Phase of Management
222. Uncomplicated Amputations
223. Complicated Amputations
224. Ulceration
225. Neuroma
226. Phantom Limb Pain
227. Heterotropic Ossification
228. Prosthesis
229. The Socket
230. The Suspension System
231. The Pylon
232. The Foot
233. Special Considerations
234. The Bilateral Amputee
235. Psychological Evaluation
236. Delayed Amputation Outcomes
237. Upper Extremity
238. Conclusion
239. Case Report
240. References
241. 18: Healing the Scars Within: Psychological Support for the War-Injured
242. Introduction: Why Include a Mental Health Chapter in a Surgery Textbook?
243. Trauma and Mind-Body Interaction
244. Trauma and War Injuries
245. Treatments Considered
246. Effect of Mental Health on Wound Healing and Physical Rehabilitation
247. Impact of Religion and Family on ARAB Psyche
248. Challenges
249. Case Discussion
250. Conclusion
251. References
252. 19: Infections in Combat-Related Wounds
253. Clinical Case
254. Introduction and Historical Perspective
255. Pathophysiology of Wound Infections
256. Diagnosis of Wound Infections
257. Microbiology of War-Related Injuries
258. Emerging Antimicrobial Resistance
259. Prophylaxis and Management of War-Related Injuries
260. References
261. Erratum to: Management of Craniomaxillofacial Injuries Ghassan Soleiman Abu-Sittah, Joe S. Baroud,
262. Index

Editor Biography

Ghassan Soleiman Abu-Sittah, MD, MBchB, FRCS(Plast)Assistant Professor of SurgeryHead of Division of Plastic & Reconstructive SurgeryAmerican University of Beirut Medical Center,Honorary Senior Clinical Lecturer, Queen Mary University of LondonRiad El-Solh / Lebanon, Building: Medical Center – Phase 1 / Floor: 8