Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.

the basic training of emergency physicians in FAST showed efficiency and usefulness in abdominal trauma assessment. Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems.

The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity.

The neck is vulnerable to trauma because of vital structures and possible major injuries with high morbidity and mortality rates. Aim:To evaluate the outcome in patients with penetrating cervical wounds. Methods:The medical registries of 39 patients were analyzed retrospectively from 2001 to 2009. Penetrating wounds were defined as injuries that penetrated beyond the platysma muscle. Age, gender, etiology, wound site, injured structures, treatment, and outcome were analyzed. Fisher's exact test was adopted to establish the link between these variables and the outcome (discharge or death).Results: Of 39 patients, 33 (84.62%) were men with a mean age of 28 years. The main cause was firearm projectiles -19 (48.72%) cases; the most frequently affected zone was zone II -29 (74.36%). Thirteen (33.3%) cases of hemodynamic instability were observed, and the average hospital stay was 14 (1-99) days. The main indication for surgical intervention was the presence of profuse hemorrhage, in eight (20.5%) cases. The main structures affected were the cervical veins (20.5%). There were eight (20.51%) deaths. Younger patients had a better prognosis.

The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity. RESUMO A cirurgia de controle de danos, com ênfase em peritoneostomia, geralmente resulta em retração da aponeurose e perda da capacidade de fechar a parede abdominal, levando à formação de hérnias ventrais incisionais. Atualmente, várias técnicas oferecem maiores chances de fechamento da cavidade abdominal, com menor tensão. Deste modo, este estudo tem por objetivo avaliar três técnicas de fechamento temporário da cavidade abdominal: fechamento a vácuo (Vacuum-Assisted Closure Therapy - VAC), Bolsa de Bogotá e Vacuum-pack. Realizou-se uma revisão sistemática da literatura com seleção de 28 artigos publicados nos últimos 20 anos. As técnicas de Bolsa de Bogotá e Vacuum-pack tiveram como vantagem o acesso fácil ao material, na maioria dos centros, e baixo custo, ao contrário do que se observa na terapia a vácuo, VAC, que além de apresentar alto custo, não está disponível em grande parte dos hospitais. A técnica VAC, por outro lado, foi mais eficaz na redução da tensão nas bordas das lesões, ao remover fluidos estagnados e detritos, além de exercer ação a nível celular, aumentando as taxas de proliferação e divisão celular, e apresentou as maiores taxas de fechamento primário da cavidade abdominal.