Andrew W Kirkpatrick1, Jessica Lynn McKee2, Colonel Homer Tien3, Anthony J LaPorta4, Kit Lavell5, Tim Leslie6, Paul B McBeth7, Derek J Roberts8, Chad G Ball9. 1. Canadian Forces Health Services, Nationwide, Canada; Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada. Electronic address: Andrew.kirkpatrick@albertahealthservices.ca. 2. Innovative Trauma Care, Edmonton, AB, Canada. 3. Canadian Forces Health Services, Nationwide, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4. Rocky Vista University School of Medicine, CO, USA. 5. Strategic Operations, San Diego, CA, USA. 6. Flight Research Laboratory, National Research Council of Canada, Ottawa, ON, Canada. 7. Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada. 8. Department of Surgery, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada. 9. Department of Surgery, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
Abstract
INTRODUCTION: Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g). METHODS: Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS. RESULTS:Ten surgeons participated. Two (40%) surgeons randomized to suture in 0g were incapacitated with motion-sickness, and none were able to close in either 1 or 0g. With WC, two completely closed in 1g as did three in 0g, despite having longer incisions (p = 0.016). Overall skin-closure with WC was significantly greater in both 1g (p = 0.016) and 0g (p = 0.008). CONCLUSIONS: WC was more effective in 1g and particularly 0g. Future studies should address the utility of abbreviated WC abdominal closure to facilitate potential Far-Forward DCL. TRIAL REGISTRATION: ID ISRCTN/77929274.
RCT Entities:
INTRODUCTION: Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g). METHODS: Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS. RESULTS: Ten surgeons participated. Two (40%) surgeons randomized to suture in 0g were incapacitated with motion-sickness, and none were able to close in either 1 or 0g. With WC, two completely closed in 1g as did three in 0g, despite having longer incisions (p = 0.016). Overall skin-closure with WC was significantly greater in both 1g (p = 0.016) and 0g (p = 0.008). CONCLUSIONS: WC was more effective in 1g and particularly 0g. Future studies should address the utility of abbreviated WC abdominal closure to facilitate potential Far-Forward DCL. TRIAL REGISTRATION: ID ISRCTN/77929274.
Authors: Ian A. McKee; Jessica L. McKee; Brian E. Knudsen; Ryan Shelton; Tony LaPorta; Juan Wachs; Andrew W. Kirkpatrick Journal: Can J Surg Date: 2019-12-01 Impact factor: 2.089
Authors: Jochen Hinkelbein; Steffen Kerkhoff; Christoph Adler; Anton Ahlbäck; Stefan Braunecker; Daniel Burgard; Fabrizio Cirillo; Edoardo De Robertis; Eckard Glaser; Theresa K Haidl; Pete Hodkinson; Ivan Zefiro Iovino; Stefanie Jansen; Kolaparambil Varghese Lydia Johnson; Saskia Jünger; Matthieu Komorowski; Marion Leary; Christina Mackaill; Alexander Nagrebetsky; Christopher Neuhaus; Lucas Rehnberg; Giovanni Marco Romano; Thais Russomano; Jan Schmitz; Oliver Spelten; Clément Starck; Seamus Thierry; Rochelle Velho; Tobias Warnecke Journal: Scand J Trauma Resusc Emerg Med Date: 2020-11-02 Impact factor: 2.953
Authors: Andrew W Kirkpatrick; Ian A McKee; Brian Knudsen; Ryan Shelton; Anthony J LaPorta; Juan Wachs; Jessica L McKee Journal: Can J Surg Date: 2022-04-01 Impact factor: 2.089