Biomedical subjects

Grant Bochicchio

Publications and source records attributed to Grant Bochicchio.

4 recordsLinked to original sources

PubMed2007

The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma.

BACKGROUND: Trauma patients with high-energy injuries often present with severe tissue damage that extends beyond the immediate zone of injury and requires recruitment of vascularized tissues from distant sites. The objective of this study was to evaluate the utility of the anterolateral thigh (ALT) flap for reconstruction of the traumatically injured lower extremity. METHODS: Prospective data were collected on all patients who underwent lower extremity reconstruction with an ALT flap during a 3.5-year period at a primary adult resource center (PARC). Demographics captured included age, gender, Injury Severity Score, mechanism of injury, and size of defect and complications. RESULTS: Fifty-six patients underwent a total of 59 ALT flap harvests during the study period. The majority of patients were male (75%) and sustained blunt injury (95%). The mean age was 37 +/- 14 years with a mean Injury Severity Score of 17.9 +/- 8. The mean flap size was 20.7 x 8.4 cm, with 64% harvested from the injured limb. Total flap success rate was 91.5%, with four total (6.7%) and one partial flap failure (1.7%). CONCLUSION: The ALT flap is a useful tool for trauma reconstruction in lower extremity salvage. We have shown that the ALT flap can be performed successfully in the traumatically injured patient even when harvested from the ipsilateral lower extremity.

Adult↗

PubMed2004

The combination of platelet-enriched autologous plasma with bovine collagen and thrombin decreases the need for multiple blood transfusions in trauma patients with retroperitoneal bleeding.

OBJECTIVES: Bleeding from blunt and penetrating retroperitoneal injuries during operative exploration are often difficult to control surgically and can be associated with significant blood loss. Our goals were to evaluate and compare the efficacy of a topical autologous platelet-enriched plasma combined with bovine collagen and thrombin (PCT) to Gelfoam/thrombin (G/T) in relation to hemostatic control/blood transfusion (BTx) requirements and subsequent outcome. METHODS: Prospective data were collected on all patients who underwent operative exploration for retroperitoneal injuries in which either PCT or G/T was applied with or without packing over a 2.5-year period. Patients were stratified by age, gender, mechanism of injury, preoperative international normalized ratio, pH, hematocrit, intraoperative blood loss, and BTx requirements. Subsequent BTx requirements were calculated within 48 hours of the surgical procedure. Outcome was measured by intensive care unit and hospital length of stay and mortality. RESULTS: A total of 78 patients met study criteria. Patients who received G/T had a significantly greater number of early postoperative transfusions (p < 0.001) and a longer hospital (p < 0.001) and intensive care unit length of stay (p < 0.007). There was no difference in mortality. CONCLUSION: PCT is a rapidly available topical hemostat that is associated with a significant decrease in the need for postoperative blood transfusions and intensive care unit and hospital length of stay. A randomized prospective trial to confirm these results is warranted.

Adult↗

PubMed2004

Computer-assisted communication for critically ill patients: a pilot study.

BACKGROUND: Critically ill nonverbal patients often have limited means of communication through eye-blinking, communication cards, and occasionally writing. We evaluated a novel computer communication device to determine its clinical utility as an alternative form of communication between patients and hospital staff. METHODS: We conducted a prospective pilot study to evaluate a communication system (LifeVoice) for intubated nonverbal trauma patients. Patients and hospital staff completed questionnaires regarding product satisfaction and utility on days 1, 3, and 7. RESULTS: Patients (n = 35) felt the system assisted them in obtaining their needs (>90%). Hospital staff (n = 42) felt the device improved patient care (96%) and comfort (91%). CONCLUSION: The system evaluated offers an effective alternative to traditional means of communication in the intensive care unit. Computer-assisted communication improves patient comfort and allows advanced patient participation in medical care. Further studies will determine whether this modality objectively improves patient care by promoting a higher degree of safety and reducing medical errors.

Adult↗

PubMed2003

Air following splenic embolization: infection or incidental finding?

The use of splenic embolization for nonoperative management has increased. With increased use of this adjunct, a new and frequent finding has been air within the areas of infarction in patients with or without clinical signs of infection. The purpose of this study was to determine if air within areas of splenic infarction is pathologic of infection or rather an incidental finding. A retrospective review over the past 3 years of inpatients undergoing splenic embolization and having pre- and postembolization abdominal computed tomography scans were reviewed for the findings of free air as well as any clinical signs of infection. A total of 96 consecutive patients were included. Of these, 12 had evidence of infarction with air. Six of these patients had undergone distal embolization with intraparenchymal air, but no symptoms. These were successfully observed. Two patients demonstrated subcapsular air/fluid levels, which underwent drainage with splenic preservation. Cultures were negative for infection. The remaining 4 underwent splenectomy. Of these, all had large collections of air. Two of these 4 spleens were infected: 1 with alpha-hemolytic Streptococcus and one with Clostridia perfringens. The remainder was sterile. This gave an overall infection rate of 17 per cent of patients with evidence of air. This yield increased to 33 per cent if the patient had symptoms and 50 per cent in those with large amounts of air and symptoms. Overall, we feel that air following embolization is a concern, but does not constitute infection. Patients with large amounts of air and signs and symptoms of infection will have a far higher infectious rate, 50 per cent in this limited series. In these patients, evaluation for infection is indicated; that being percutaneous sampling versus splenectomy.

Embolization, Therapeutic↗