Trauma Surgery Unit

Department of Surgical Disciplines

• Consultants: 5

• Senior Residents Ward: 4-10

• Senior Residents ED: 4

• Senior Residents ICU: 3

• Academic Junior Residents: 2-6 (on rotation)

• Maxillo-facial Junior Resident: 1

• Non-academic Junior Residents: 6-10

• Total beds: Wards - 42 & ICU – 12

• OR: Elective – Daily 1-2 tables/ Emergency 24x7

• Follow-up Clinic: Triweekly

• Specialty clinics: Monday – Torso trauma F/U

Disability clinic

Maxillofacial clinic - biweekly

• Morbidity & Mortality meet: Every Monday

• Radio-conference: Every Tuesday

• Census: Quarterly & Annually

• Seminars: Thursdays

• Total patients attending ED: 48352

29236%

959920%

3583074%

Red Area

Yellow Area

Green Area

• Interventions in ED

• ICD: 214

• Tracheostomy: 7

• Cricothyroidotomy: 8

• Suturing: 21451

• SPC: 19

1091, 67%

531, 33%

ED

F/U Clinic

Total

1622

0

200

400

600

800

1000

1200

1400

1600

1800

2010 2011

1092 1091

676531

Follow-up

ED

42,000

44,000

46,000

48,000

50,000

52,000

54,000

56,000

2010 2011

47767 48352

59497110

F/U Clinic

ED

136

104

163

131139

130 132 135142

133123

116

0

20

40

60

80

100

120

140

160

180

Admissions

• Pediatric : 183 (11.2%)

1328, 82%

294, 18%

Male

Female

624, 57%

189, 17%

122, 11%

32, 3%27, 3%

97, 9%

RTI

Assault

FFH

Railway

Suicidal

Unintentional

87854%

19412%

47729%

735%

Torso

Maxillofacial & Neck

Skin & Soft Tissue

Vascular

44551%

33138%

10211%

Abdomen & Pelvis

Thoracic

Combined

Total: 878 (54%)

76687%

11213%

Blunt

Penetrating

Mechanism of Injury

0

50

100

150

200

250

300

350

400

Abdomen Thorax Combined

389

294

83

47 31

159 6 4

Blunt

LVI

HVI

Total cases: 445

17840%

10724%

6715%

215%

7216%

Solid Organ

Hollow Viscus

Genitourinary

Pancreatico-duodenal

Others

9855%

7542%

53%

Liver

Spleen

Combined

Total: 178

2331%

3850%

1419%

Total: 75

Operative

Non-operative

Angioembolisation

5758%

2930%

1212%

Total: 98

Nonoperative

Operative

Angio-embolisation

1362%

733%

15%

Total: 21

Pancreas

Duodenum

Combined

1257%

943%

Total: 21

Operative

Non-operative

1319%

4669%

710%

12%

Total: 67

Renal

Urethral

Bladder

Ureteric

539%

646%

215%

Total: 13

Operative

Non-operative

Angio-embolisation

2342%

1629%

1222%

23%

24%

N=55

Hollow Viscus

Solid Organ

Pelvis & RPH

Pancreas

Genito-urinary

29288%

3912%

Total cases: 331

Non-operative

Operative

24690%

2710%

With ICD

Without ICD

1359%

941%

N=22

Operative

Non-operative

Total cases: 194

16284%

3216%

Maxillo-facial

Neck

Mode of Injury

Homicide – 5

Suicide – 1

RTI – 4

Unintentional -1

Part Involved

Larynx – 3

( 2 Thyroid

cartilage, 1 cricoid

cartilage)

Trachea – 5

Carina – 2

Rt main bronchus – 1

Lt main bronchus – 1

Management

Tracheostomy – 4

Tracheal repair + tracheostomy –

4

FOB + Fibrin glue – 1

FOB – 2

Bronchial repair – 1

Total cases: 477

20743%

14430%

6414%

6213%

Lower Limb

Upper Limb

Combined

Others

34%

46%

1723%

1115%

1216%

1318%

57%

34%

57%

Total: 73

Aorta

Axillary

Brachial

Ulnar

Radial

Femoral

Popliteal

IVC

Others

Artery <6hrs 6-12hrs >12hrs Amputatio

n

Success%

Ulnar 6 5 0 0 100

Radial 9 3 0 0 100

Brachial 9 (1) 7 (2) 1 (1) 4 76.5

Axillary 0 4 (1) 0 1 75

Femoral 6 (1) 5 (3) 2 4 69.2

Popliteal 1 3 (1) 1 1 80

Success Rate: 74.4%

2

7

0

1

2

3

4

5

6

7

8

< 6 hrs 6 - 12 hrs

Amputation Rate

• Pseudo-aneurysm 5 cases – three managed with stenting

two surgically.

• Both radial and ulnar involved in 6 cases

• Superficial sharp cut wrist injuries - 25 cases

(20 associated with nerve & tendon injuries)

• External Iliac art -1,vein 2 cases

• SMA- 1,IMA-1

• Aortic dissection – 3 cases

51537%

393%

17112%78

6%

645%

614%

36427%

856%

Abdominal

Thoracic

Plastic & Reconstructive

Extremities

Vascular

Neck

Skin & Soft Tissue

Maxillofacial

Total: 1713

1335

252

126

Total: 1713

GA

Regional

LA

5210%

18736%

5912%

122%

153%

184% 172

33%

Solid Organ

Hollow Viscus

Genitourinary

Pancreaticoduodenal

Laparoscopic

Diaphragm

Others

Total Cases: 515

1983%

417%

Spleen: 23

Splenectomy Splenorraphy

2276%

724%

Liver: 29

Packing Repair/Hepatectomy

1823%

3545%

1317%

911%

34%

Gastric Trauma Jejunal Trauma

Ileal Trauma Colonic Trauma

Esophagus

Ileostomy: 15

Sigmoid Colostomy: 31

Transverse Colostomy: 14

Ileostomy Closures: 17

Colostomy Closures: 20

Cervical Esophagostomy: 3

Feeding Jejunostomies: 17

Appendectomy: 1

Cholecystectomy: 4

Pancreatico-duodenal: 12

434%

217%

18%

18%

18%

325%

Distal Pancreatectomy with Splenectomy

Distal Pancreatectomy

Tail Repair

Necrosectomy

Whipple's

Duodenal

Genito-urinary: 59

47%

11%

712%

4373%

12%

12%

23%

Nephrectomy

Partial Nephrectomy

UB Repair

SPC

Cystoscopy

Ureteric Repair

Ureteric stent

6940%

1710%

2414%

1810%

53%

106%

159%

95%

53%

Laparostomy

EL with Packing

EL with Lavage

Diaphragm RepairRetropubic PackingHernioplasty

B/L IIA Ligation

Mesenteric Tears

Negative EL

Others: 172

1063%

425%

16%

16%

Negative DL

Positive DL

False Positive DL

DPL

Negative Therapeutic Laparotomies prevented in: 93.33%

Total: 39

2564%

821%

615%

Thoracotomy

VATS

Cardiac

Bronchoscopy: 19

Massive Hemothorax: 7

Decortication: 7

Resuscitative: 7

Diaphragm Repair: 1

Lobectomy: 1

Foreign Body: 1

Pericardiotomy & Hemothorax: 1

Foreign Body: 1

Tamponade: 1

Ventricular rent: 4

Total: 85

7487%

1113%

ORIF

IMF

Total: 171

Flaps:60

Advancement – 16

Transposition – 14

Rotation – 16

Gastrocnemius – 5

Groin – 4

Bipedicle – 2

LD – 1

Free flaps – 2

Nerves & Tendons:

63

Tendons – 39

Median N –6

Ulnar N – 14

Radial – 4

Reconstructive

& Re-implant: 31

Orbital Floor – 5

Earlobe – 11

Nose – 4

Lip – 4

Tongue – 2

Hand – 1

Leg -1

Digits – 4

Penile – 1

Others: 17

Z – Plasty – 3

V-Y Plasty – 3

Contracture release –

11

End to end Anastomosis - 35

Ulnar – 11

Radial – 12

Brachial – 7

Femoral – 4

Popliteal – 1

PTFE Graft - 6

Axillary – 3

Femoral – 3

Saphenous Vein Graft - 9

Brachial – 3

Popliteal – 2

Femoral – 3

Axillary – 1

EA & Thrombectomy - 14

Popliteal – 2

Brachial – 7

Femoral – 5

Total: 78

1422%

1929%

812%

812%

23%

58%

711%

23%

AK

BK

AE

BE

Foot

Hip disarticulation

Digits

Faciotomies

1931%

3862%

47%

Total: 61

Neck Explorations

Tracheostomies

Tracheal Repair

Total: 364

25370%

8423%

277%

STSG

Debridement

Combined

1429%

1225%

24%

511%

511%

24%

12%

36%

48%

Total: 47

Splenic A

Hepatic A

Renal A

Face

ICA

Subclavian A

Lumbar A

Lower limb

Abdomen

IVC Filter: 1

Total: 117 (7.2%)

7161%

4639%

Early < 72 hrs

Late > 72 hrs

6858%

3732%

76%

54%

Total: 117

Hemorrhagic Shock

Sepsis

ARDS

MODS

4337%

2219%

119%

1210%

98%

1412%

65% Abdomen

Chest

Combined

Pelvis

Head

Polytrauma

Others

Total: 117 (7.2%)

0

10

20

30

40

50

60

70

80

0 20 40 60 80 100 120

ISS Scores

ISS Scores

• 3 cases

• 1) RTA with Severe Head Injury & Pelvic # - ISS 16

• 2) BTA with Pancreatic tail transection – ISS 17

• 3) RTA with BTA with ileal perforation with pelvic # - ISS

19

Date No. of

Victims

Mechanism

8/1/11 9 Collapse of huts

20/1/11 5 Collision of car with stationary truck

28/2/11 6 Collision involving car + truck + auto

8/3/11 6 Overturn of tempo

9/3/11 5 Collision of car with truck

11/3/11 4 Truck overturn

21/3/11 9 Clash between two groups

26/3/11 9 Civil violence

27/3/11 6 Overturn of truck

25/4/11 5 Collision of car with truck

30/4/11 5 Collision of car with truck

6/5/11 3 Collision of car with unknown vehicle

Date No. of

Victims

Mechanism

7/5/11 7 Civil violence

8/5/11 8 Collision of car with auto

11/5/11 10 Fire in a teaching institute

12/5/11 5 Collision between trucks

14/5/11 5 Collision between two cars

10/6/11 6 Fall of a residential wall

29/6/11 5 Sudden braking of an DTC bus

14/7/11 5 Car ambulance with truck collision

1/8/11 7 SUV with auto collision

1/9/11 5 Firearm injury in Muthoot finance Company

5/9/11 7 Roof collapse in a Gym

3/10/11 6 Pedestrians hit by a PCR van

• ED attendance per day is 130

• F/U Clinic attendance per follow-up day is 50

• Around 60 minor procedures done in ED per day.

• Majority of trauma victims are males.

• RTI is the most common mode of injury.

• Pedestrians were involved in 19% of RTI cases.

• Blunt injury is predominant mechanism in torso trauma

• Majority of abdominal trauma patients having solid

organ injury managed non-operatively (65%).

• Majority of thoracic trauma treated non operatively

(88%).

• Failure rate in vascular injury has decreased by 2%

• Diagnostic laparoscopy replacing DPL as a diagnostic

tool

with negative therapeutic laparotomies prevention in

93.33%.

• Increasing Pancreatico-duodenal injury and shift in trend

towards operative management.

• Increasing trend towards operative management of

Tracheo-bronchial injury

• Increasing role of interventional radiology.

• Decrease in mortality rate by 1.3%

• Most common cause of death – Hemorrhage / Sepsis