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Primary Management
in General, Vascular
and Thoracic Surgery
APractical Approach
DanieleBissacco
AlbertoM.Settembrini
AndreaMazzari
Editors
123

Primary Management in General, Vascular
and Thoracic Surgery

Daniele Bissacco • Alberto M. Settembrini
Andrea Mazzari
Editors
Primary Management in
General, Vascular and
Thoracic Surgery
APractical Approach

Editors
Daniele Bissacco
Vascular Surgery Unit
Fondazione IRCCS Ca’ Granda Ospedale
Maggiore Policlinico
Milan, Italy
Andrea Mazzari
Mini-invasive and General Surgery Unit
Ospedale Cristo Re
Rome, Italy
Alberto M. Settembrini
Vascular Surgery Unit
Fondazione IRCCS Ca’ Granda Ospedale
Maggiore Policlinico
Milan, Italy
ISBN 978-3-031-12562-1 ISBN 978-3-031-12563-8 (eBook)
https://doi.org/10.1007/978-3-031-12563-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface
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A specialist doctor is a man who knows more and more about less and less.
Dr. William J.Mayo
Fudit equum magno tellus percussa tridenti.
Virgilio, Georgiche 1 1-42
These are two phrases that strike us to the heart.
Mayo is the founder of one of the most important hospitals in the world, and his
phrase is a motto for all doctors who have married their work following the deep
meaning of the word “doctor” by taking care of all patients.
Virgil’s phrase must be translated into medical words considering that the teacher
must prepare young surgeons to learn and make their own the lessons received from
the experience of the elders.
Medicine is a eld where changes are inevitable, but changes are not always
evolutions. To be good doctors, it is imperative to know the biology and processes
of the body’s biological behavior and, from there, try to identify changes and evolutions in therapies and treatments.
Indeed, in surgery it is essential to know the difference between the basics and
the evolution of techniques.
The basics of surgery are the cornerstones of surgical growth for surgeons, but all
good doctors and surgeons must keep in mind that the rst approach to the patient
is the correct diagnosis and management.
Why? The question can be answered by tracing its historical development over
the centuries to identify the fundamental steps that depend closely on the evolution
of thought. Why? The basis of surgery is not the hands but the head.
The decision-making process is the rst and sometimes the most important condition to be addressed before treatment.
Our book is intended to be a concise but comprehensive guide for quick consultation by our younger colleagues on various clinical situations.
This book is for young surgeons by young surgeons. SPIGC (Italian
Polyspecialistic Society of Young Surgeons) has endorsed this publication because
who can be a better advisor to a young surgeon than another young surgeon who is
more experienced, more skilled, and knowledgeable in a specic eld.
Practical advice is given for all stages of management, and all chapters are rich
in references and illustrations to provide additional reading to those who want more
in-depth coverage.
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Preface
This is the reason why the authors have written very practical and up-to-date
chapters on different but frequent pathologies of the most critical surgical elds:
general, thoracic, and vascular surgery.
Milan, Italy DanieleBissacco
Milan, Italy AlbertoM.Settembrini
Rome, Italy AndreaMazzari

Contents
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1 Historical Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
E. Botteri, F. Bongiovanni, R. L. Meniconi, and E. Grespi
Part I Surgical Instruments and Materials
2 Surgical Instruments and Materials in General Surgery . . . . . . . . . . . 7
Andrea Mazzari, Pasquina M. C. Tomaiuolo,
and Roberto Luca Meniconi
3 Surgical Instruments and Materials in Thoracic Surgery . . . . . . . . . . 15
Valeria Musso and Francesco Damarco
4 Surgical Instruments and Materials in Vascular Surgery . . . . . . . . . . . 21
Ilenia D’Alessio and Matteo Marone
Part II Neck
5 Supra-aortic Trunks Emergency Conditions . . . . . . . . . . . . . . . . . . . . . 33
Enza Lucia Castronovo, Daniele Bissacco, D’Oria Mario,
Alberto M. Settembrini, and Sirignano Pasqualino
6 Upper Airways Tract in Emergency Settings . . . . . . . . . . . . . . . . . . . . . 49
Diotti Cristina and Francesco Damarco
7 Multidisciplinary Surgical Consensus on Neck Emergencies . . . . . . . . 63
Emanuela Fuccillo and Marco Giovenzana
Part III Chest
8 Chest: Surgical Anatomy and General Consideration
in Emergency Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Valeria Musso and Francesco Damarco
9 Acute Aortic Syndromes and Thoracic Aortic Aneurysms:
From Diagnosis to Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Andrea Xodo, Andrea Gallo, Paolo Magagna, and Mario D’Oria
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Contents
10 Pulmonary and Thoracic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Francesco Damarco
11 Upper Gastrointestinal Tract Acute Conditions . . . . . . . . . . . . . . . . . . . 119
Marco Giovenzana, Beatrice Giuliani, and Nicolò Maria Mariani
12 Multidisciplinary Surgical Consensus on Chest Emergencies . . . . . . . 129
Francesco Damarco, Marco Giovenzana, Diotti Cristina,
and Valeria Musso
Part IV Abdomen
13 Abdomen: Surgical Anatomy and General Consideration
in Emergency Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Sarah Molno, Giampaolo Bertoloni, and Gian Luca Baiocchi
14 Acute Abdominal Aorta and Visceral Vessel Disease . . . . . . . . . . . . . . . 145
Davide Esposito and Elena Giacomelli
15 Acute Abdomen and Acute Abdominal Conditions . . . . . . . . . . . . . . . . 153
Emanuele Botteri, Gianmaria Casoni Pattacini, Alessio Giordano,
and Francesca Ratti
16 Abdominal Emergencies Requiring a Multidisciplinary Approach . . . 175
Andrea Mazzari, Pasquina M. C. Tomaiuolo, Alessio Giordano,
Roberto Luca Meniconi, and Alberto M. Settembrini
Part V Upper and Lower Limbs
17 Upper and Lower Limbs: Surgical Anatomy and General
Consideration in Emergency Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Matteo Marone and Ilenia D’Alessio
18 Acute and Chronic Limb Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Giuseppe Galzerano, Edoardo Pasqui, Gianluca Chierchini,
Alberto M. Settembrini, and Pasqualino Sirignano
19 Popliteal Artery Aneurysm and Non- atherosclerotic Limb Disease . . . 207
Alberto M. Settembrini and Pasqualino Sirignano
Part VI Specic Clinical Pictures: Surgeon Perspectives
20 The Infected and Septic Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Emanuele Botteri, Nicoletta Lazzeri, Silvia Mazzoleni,
and Frank A. Rasulo
21 Hemorrhagic Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Samuele Colombo and Daniele Bissacco
22 The Polytrauma Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Matteo Marone and Ilenia D’Alessio

Historical Overview
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E.Botteri, F.Bongiovanni, R.L.Meniconi, andE.Grespi
1.1 New Science
Understanding the origins of ‘new’ scientic knowledge, understanding what and
who took the rst steps towards breaking free from superstition, supernatural,
rigid and immutable beliefs, is a considerable cultural step and one which brings
full enjoyment of what science can offer us both as individuals and as members of
the scientic community. Above all, intellectual effort calls for a critical mind, in
order not to simply accept what is transmitted to us. Thinking can and should be
remodelled by everyone, according to well-accepted methods to make it ever
more detailed and in keeping with the reality we wish to convey. It requires intellectual honesty, as well as specialised training, and once conclusions have been
reached about any piece of work, the results should be conveyed to everyone
involved. While ‘our’ centuries-old science has managed to overcome superstition, an anti-scientic attitude has remained on the side-lines of human thought,
threatening its very foundations whenever an immediate explanation to a phenomenon cannot be provided. Science takes time and requires patience, a sound mind
and method.
Let us not forget that many of the western world’s values and perceptions are
inspired by the scientic method and the resulting technical progress. The ‘Scientic
1
E. Botteri (*)
General Surgery Unit, ASST Spedali Civili di Brescia, Brescia, Italy
F. Bongiovanni · E. Grespi
Department of Anesthesiology and Intensive Care Medicine II, Spedali Civili, University of
Brescia, Brescia, Italy
R. L. Meniconi
Department of General Surgery and Organ Transplantation, Azienda Ospedaliera San
Camillo-Forlanini, Rome, Italy
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
D. Bissacco et al. (eds.), Primary Management in General, Vascular and
Thoracic Surgery, https://doi.org/10.1007/978-3-031-12563-8_1
1

2
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Method’, its concepts and its dissemination underpinned the veritable knowledge
revolution of the seventeenth century. The Scientic Method represents ‘the rules of
the game’ and covers three elements in its scope:
1. LOGIC and its inductive methods (the effects are observed to conrm the causes,
according to a process of subsequent reasoning) and deductive methods (from
the cause, the effects are hypothesised, according to a process of prior reasoning).
2. Systematic application of OBSERVATION, not for mere description purposes,
but rather in order to inspire EXPERIMENTATION.Every hypothesis must go
hand in hand with repetition and reproducible tests in order for it to be afrmed.
3. Speaking the same language: the language of MATHEMATICS.Galileo Galilei
claimed that ‘the universe is written in the language of mathematics’. Used in
Plato’s era as the language of nature, especially in geometry, to avoid being misled by pure sensory experiences.
The main advocates of this development were three scientists closely linked to
one another by the knowledge that ‘we have been too inefcient thus far’, Galileo
Galilei, Renè Descartes and Francis Bacon.
Nevertheless, New Science gured little, at least to begin with, in the world in
which it emerged. Inevitably, new institutions were needed; composed of people
involved with specic scientic elds, supported by patrons or corporations with
the aim of facilitating communication and debate in the scientic community—the
SCIENTIFIC SOCIETIES were born.
1606 saw the launch of Rome’s Lincean Academy, quickly followed by the
Accademia del Cimento (1657), Paris’ Academy of Sciences (1666) and the Royal
Society (1660). In the latter, the inuence of the new cultural climate was so strong
that the ne arts, rhetoric, metaphysics and theology were excluded from the Articles
of Association (without, however, undermining their prominence). The importance
of communicating ideas was supported by their own dissemination means and journals such as the Philosophical Transaction, Acta Eruditorum and the Journal de
Savants.
At all levels, scientic research products should therefore be made accessible,
employing the correct language for the target audience.
E. Botteri et al.
1.2 Young People inScience
When we speak about young people in science, particularly about the contribution,
young people have made, make and will make, is not only a matter of age. Being
young implies a new mental approach and boundless physical endurance. One could
wonder who was the rst ‘young surgeon’ to have both a young mind and a youthful
age. There is no doubt as to the answer: Giovanni Battista Morgagni (Forlì 1682Padua 1771). He studied under Valsalva in Bologna before moving to the Republic
of Venice and nally settling down in Padua in 1711, when he was called to the
second chair of theoretical medicine.
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