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Updates in Surgery
OsvaldoChiaraEditor
Trauma Centers
and Acute Care
Surgery
ANovel Organizational and Cultural
Model
Updates in Surgery
The aim of this series is to provide informative updates on hot topics in the areas of
breast, endocrine, and abdominal surgery, surgical oncology, and coloproctology,
and on new surgical techniques such as robotic surgery, laparoscopy, and minimally
invasive surgery. Readers will nd detailed guidance on patient selection,
performance of surgical procedures, and avoidance of complications. In addition, a
range of other important aspects are covered, from the role of new imaging tools to
the use of combined treatments and postoperative care.
The topics addressed by volumes in the series Updates in Surgery have been
selected for their broad signicance in collaboration with the Italian Society of
Surgery. Each volume will assist surgical residents and fellows and practicing
surgeons in reaching appropriate treatment decisions and achieving optimal
outcomes. The series will also be highly relevant for surgical researchers.
More information about this series at http://www.springer.com/series/8147
Osvaldo Chiara
Editor
Trauma Centers and Acute
Care Surgery
A Novel Organizational
andCultural Model
Editor
https://t.me/medicina_free
Osvaldo Chiara
General Surgery and Trauma Team
Niguarda Hospital
Milan
Italy
Department of Pathophysiology and Transplantation
University of Milan
Milan
Italy
The publication and the distribution of this volume have been supported by the Italian Society
of Surgery
ISSN 2280-9848 ISSN 2281-0854 (electronic)
Updates in Surgery
ISBN 978-3-030-73154-0
https://doi.org/10.1007/978-3-030-73155-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2021
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.
Revision and editing: R. M. Martorelli, Scienzaperta (Novate Milanese, Italy)
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
ISBN 978-3-030-73155-7 (eBook)
Foreword
https://t.me/medicina_free
It is at the same time a pleasure and an honor for me to introduce to the surgical
community the excellent work of Professor Chiara in the traditional format used by
the Italian Society of Surgery. It is also the appropriate occasion to congratulate my
colleague on the extensive documentary work that offers the most qualied surgical
readers an organic analysis of the modern problems surrounding the general management, logistics, and organization of a trauma center, while emphasizing the universally acquired model of coordinated multidisciplinary management of
polytrauma, without overlooking the peculiarities of the different anatomical districts and systems.
The result is a complete, specic, and highly specialized review of the most
important aspects of trauma care.
This book carefully guides the reader through the complex world of trauma centers and related aspects. It is destined to become a reference text in the variegated
bibliographic landscape of monographs devoted to trauma and trauma centers,
bringing the readers up to date on the most advanced techniques of polytrauma
management, the results acquired, and the scientic debate surrounding the principal, yet still controversial, topics.
Looking at the results of this major endeavor, I would like to express, on behalf
of the SIC, our gratitude to the editor and authors for presenting us with a tangible
sign of their extensive eld experience in a monograph that maintains the traditional
high standard of the monothematic publications of the Italian Society of Surgery.
Catania, Italy Francesco Basile
September 2021 President
Italian Society of Surgery
v
Preface
https://t.me/medicina_free
The history of trauma systems started in the US and, since the beginning, surgeons
were launched into a full stewardship. In Europe, anesthesiologists and emergency
physicians were more involved in trauma leadership but few surgical groups in the
UK, Germany, and Italy, with a visionary interest toward emergency situations,
joined in this path. Some studies on preventable trauma deaths attracted the attention of politicians sensitizing them to the need to institute an organized system
founded on the concept that pre-hospital health care personnel should recognize and
transport severely injured patients in the shortest time to the appropriate hospital
capable of treating all injuries 24/7. Emergency Medical Systems and Trauma
Centers were developed in almost all countries, both in North America and in
Europe, with different models, different criteria for hospital standards, but with the
same aim: to improve the care of the injured and to decrease the mortality due to
trauma. In this period, a strong foundation and a springboard for the development of
a trauma surgery discipline was established. In the rst Trauma Center in the US,
the Cook County Hospital in Chicago, Illinois, the Trauma and Burn unit greatly
inuenced the development of other activities, such as trauma radiology, trauma
anesthesia, laboratory support, and computerized trauma registry. The rst statewide trauma system was developed in the 1970s in Maryland with the Maryland
Institute of Emergency Medical Service System (MIEMSS), which set up a sophisticated communication system, interfacing the emergency call center, paramedics
on the scene, and doctors in the emergency room. The Baltimore Shock and Trauma
Center, later dedicated to its founder, Dr. R. Adams Cowley, rapidly became one of
the most crowded around the world, a model for the organization, protocols of care,
and research in the eld of trauma. Hundreds of well-equipped emergency ambulances, with thousands of pre-hospital providers, State Police helicopters, a levelone adult and a pediatric Trauma Center in Baltimore, and several lower-level
facilities, realized an impressive network for the care of the injured.
The decrease in penetrating trauma and the improvement of techniques for nonoperative management of solid organ injuries signicantly reduced the number of
operations by the general surgeon and a trauma surgery career became less attractive. This crisis had its nadir at the beginning of the new century and the solution
was found with the creation of a new discipline that encompassed general and emergency surgery, trauma, rescue surgery, and surgical critical care. The discipline of
“Acute Care Surgery” was born. This model had already been applied in Italy since
vii
viii
https://t.me/medicina_free
Preface
the 1970s. Professor Vittorio Staudacher founded the rst Italian surgical school for
Emergency Surgery: the care of trauma and non-trauma emergencies all over the
body was the proposal, with the knowledge of the pathophysiology of critically ill
patients as a guide to make the most appropriate choices in time-dependent illnesses. In the Milan Institute of Emergency Surgery, led by Professor Staudacher,
general surgeons developed different skills: some were interested in thoracic surgery, others in vascular surgery, others still in musculoskeletal surgery. Dedicated
anesthesiologists, an emergency physician, and a cardiologist all worked exclusively inside the institute. A surgical intensive care unit with three beds (the socalled anti-shock room) managed by general surgeons was available—an
ante-litteram model of an acute care surgery service and of a multidisciplinary facility for emergency care.
Nowadays, acute care surgery is spreading around the world and a career in this
eld is again attractive for young general surgeons. Probably in the near future general surgeons expert in acute care will be in great demand by hospitals with emergency departments, because the gure of a surgeon capable of managing
life-threatening conditions in all body districts is currently missing.
In this book, the organizing criteria for an acute care surgery service and the
major clinical challenges in both trauma and general emergencies have been considered. I would like to conclude this preface with a sentence by Dr. Cowley, the pioneer of trauma systems:
Every critically ill or injured person had the right to the best medical care and not according
to location, severity of injury or ability to pay.
Milan, Italy OsvaldoChiara
September 2021
Contents
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Part I Acute Care Surgery: Concept and Organization
1 A Tale of Two Cities: The Development of Trauma
and Acute Care Surgery Between Baltimore and Milan . . . . . . . . . . . . 3
Shailvi Gupta and Thomas Scalea
2 Organization and Training in Trauma
and Acute Care Surgery in Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Osvaldo Chiara and Stefania Cimbanassi
3 The Development of a Regional Trauma Registry . . . . . . . . . . . . . . . . . 21
Fabrizio Sammartano and Laura Briani
4 Quality Assessment in Acute Care Surgery . . . . . . . . . . . . . . . . . . . . . . 31
Federico Coccolini, Camilla Cremonini, Dario Tartaglia,
Enrico Cicuttin, Michael Sugrue, Randal Parlour, Ian Stephens,
Brendan Skelly, and Massimo Chiarugi
Part II Principles of Trauma Care
5 Diagnostic Protocols in Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Stefania Cimbanassi and Osvaldo Chiara
6 Damage Control Surgery: An Update . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Stefania Cimbanassi and Osvaldo Chiara
7 Damage Control Resuscitation and Massive Transfusion . . . . . . . . . . . 77
Marc Maegele
8 Definitive Care of Abdominal Solid Organ Injuries . . . . . . . . . . . . . . . 93
Chiara Cipressi, Guido Fallani, Jacopo Neri, and Gregorio Tugnoli
9 Trauma to the Chest: The Role of the Trauma Surgeon . . . . . . . . . . . . 105
Osvaldo Chiara and Stefania Cimbanassi
10 Abdominopelvic Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Massimo Chiarugi, Camilla Cremonini, Dario Tartaglia,
Enrico Cicuttin, and Federico Coccolini
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Contents
Part III Emergency General Surgery
11 The Open Abdomen: Indications and Techniques . . . . . . . . . . . . . . . . . 145
Sergio Ribaldi, Antonella Puzzovio, and Federica Scarno
12 Enteroatmospheric Fistula: A Challenge of Acute Care Surgery . . . . . 155
Roberto Bini, Stefano Piero Bernardo Ciof, and Luca Del Prete
13 Operative Endoscopy in Gastrointestinal
and Biliopancreatic Acute Care Surgery . . . . . . . . . . . . . . . . . . . . . . . . 167
Massimiliano Mutignani, Lorenzo Dioscoridi, and Mutaz Massad
14 Point-of-Care Ultrasound in Acute Care Surgery:
A Strategic Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Mauro Zago, Hayato Kurihara, Diego Mariani, Alessia Malagnino,
Marina Troian, and Alan Biloslavo
15 Large Bowel Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Vittoria Pattonieri, Gennaro Perrone, Antonio Tarasconi,
Hariscine K. Abongwa, Giacomo Franzini, and Fausto Catena
16 Biliary Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Luca Ansaloni, Paola Fugazzola, and Matteo Tomasoni
17 Management of Infected Necrosis in Severe Acute Pancreatitis . . . . . . 221
Ari Leppäniemi
18 Source Control in Abdominal Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Massimo Sartelli
19 Laparoscopy and Minimally Invasive Surgery Techniques
in Acute Care Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Francesco Virdis, Mauro Podda, Isabella Reccia, Gaetano Gallo,
Mansoor Khan, Matthew Martin, and Salomone Di Saverio
20 Emergency Management of Caustic Injuries . . . . . . . . . . . . . . . . . . . . . 249
Mircea Chirica, Florence Jeune, Helene Corte, and Pierre Cattan
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