Surgery Commons^™

Traumatic Rupture Of Gall Bladder After Blunt Trauma, Chris Robert, Alicia Lay

North Texas Research Forum 2025

Introduction: Gallbladder injury accounts for less than 1% of the patient presenting with blunt abdominal trauma, due to its protected location in the undersurface of the liver. Case report: A 41-year-old male presented to the emergency department after a motor vehicle collision. Patient was hemodynamically stable; on exam, patient had focal tenderness in the lower abdomen. Initial lab results revealed elevated blood alcohol of 302 mg/dl, elevated lactate of 3.9 mmol/l, a white blood cell count of 6.76 K/mm3, and a hemoglobin of 15.2 g/dl. Patient was pan-scanned as per trauma protocol. A computed tomography scan revealed a mesenteric hematoma …

Complete Gastric Transection After Blunt Force Trauma, Sydney Parker, Sophia Jimenez, Riley Blanton, Samprit Karra, Alejandro Garcia

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Optimizing Fluid Resuscitation: Balancing Access Efficiency And Infusion Speed In Trauma Care, Chris Robert, Enoch Wong, David Bassa, Danielle Pigneri, Paul Granet

North Texas Research Forum 2025

Study Objective: Time is a critical resource during the initial treatment of an injured patient. Fluid resuscitation is also a critical component of trauma care. Clinicians are faced with the need to actively resuscitate an injured patient while simultaneously working to provide them operative or procedural hemorrhage control as quickly as possible. In these circumstances, physicians must balance perceived flow efficiency with time required to place certain types of access devices, though little data exists to guide this decision process. This study aims to evaluate the infusion times of different sizes of peripheral and central venous catheters to optimize fluid …

There’S A Qr Code For That: Trauma Performance Improvement, Patient Safety, And Peer Review, April Miller, Luis Taveras, Elizabeth Kim, Kathy Galt

North Texas Research Forum 2025

In preparation for our facility’s initial ACS verification visit, a Trauma Consultative Site visit in 2021 identified the need for a streamlined process to communicate issues to the Trauma Program that were recognized during patient care. This was especially true on weekends and nights when issues were most likely to occur. A recent literature review revealed implementation of electronic communication tools increased reporting of performance improvement and patient safety (PIPS) events and improved tracking and resolution of events. The authors of that study used a virtual chatroom accessible from cell phone to post PIPS events. One perceived drawback to this …

Traumatic Aortic Transection, A Case Report, Jared Duval, Ernest Gonzalez

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Leveraging Clinical Standards To Improve The Translational Relevance Of Therapies For Experimental Spinal Cord Injury, Aaron L. Silverstein

Theses and Dissertations--Neuroscience

Efforts to improve treatment of spinal cord injury (SCI) often use animals to develop effective therapeutics, intending to improve the survival and the quality of life of persons with SCI. Over half of all SCIs in the United States occur at the cervical level and often cause locomotor deficits and life-threatening breathing dysfunction. Thus, my dissertation is focused on this important patient population.

After beginning with a description of translational research and surveying SCI from a clinical standpoint, I turned to describe experimental models of cervical SCI and more detailed neuroimmunological findings relevant to my work. Then, I conducted a …

Case Report: Delayed Presentation Of Midline Diaphragmatic Hernia After Blunt Trauma: A Case Repor, Aziza Win, Jason Clark, Kellie Amodeo, James Benner

South Atlantic Division GME Research Day 2025

No abstract provided.

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Spontaneous Rupture Of A Splenic Artery Aneurysm With Hemoperitoneum; Case Presentation, Vlad Denis Constantin, Ion Motofei, Gelu Valentin Stefanescu, Adrian Silaghi

Journal of Mind and Medical Sciences

Aneurysms of the splenic artery are relatively rare, being found in patients with portal hypertension, multiparous, atherosclerosis, or in young people with various genetic diseases. In the uncomplicated forms, splenic artery aneurysms are often difficult to diagnose either because of the asymptomatic evolution, or because of the non-specific symptoms. In cases of trauma or large sizes, aneurysms can be complicated by rupture, which can cause hemoperitoneum with the risk of death if specific treatment is not initiated as soon as possible. Depending on the location of the splenic aneurysm, comorbidities, the patient's general condition or life-threatening complications, laparotomy, laparoscopy, endovascular …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

Rare Right-Sided Posterolateral Diaphragmatic Hernia In An Adult Presenting As An Incarcerated Large Bowel Obstruction: A Case Report, Tanya J. T. Starr, Andrew G. Nicholson, Maximillian J. H. Starr, Jessica A. Traxler, Peter Y. Chu

HCA Healthcare Journal of Medicine

Introduction

A diaphragmatic hernia (DH) is a defect within a part of the diaphragm that allows intra-abdominal contents to enter the thoracic cavity. Diaphragmatic hernias can be congenital or acquired later in life. The most common congenital DH is the Bochdalek hernia (posterolateral hernia), but the most commonly acquired DH is due to traumatic injury. These hernias are rare in adults and are typically diagnosed incidentally. Surgical repair is the standard of care; however, data regarding the surgical approach is scarce. We report a case of a rare right posterolateral DH in an adult female patient who presented with acute …

Team-Centered Care After Trauma Patient Death: Promoting Healers’ Healing By Humanizing Our Roles, Sydni Au Hoy, Carlie J. Arbaugh, Caitlin P. Bungo, Amanda J. Deutsch, Bonnie E. Chow, Kristen Gallegos, Nerissa Alansalon, Emmanuel Jisrawi, Al’Ai Alvarez, Brooke Gurland, Joseph Forrester

Journal of Wellness

Introduction: Recurrent exposures to adverse patient events, including death, affect all members of the care team and can have long-term effects on clinician performance, personal well-being, and patient safety. Recognizing the impact of patient deaths on care teams is essential to mitigating potential risks of increased clinician burnout. We share the outcomes of a three-month pilot wellness intervention implemented at a busy academic hospital, directed explicitly toward resuscitation care teams managing patients who die from traumatic injuries.

Approach: A collaborative group from Stanford’s Trauma Surgery, Emergency Department (ED), and well-being leadership developed an integrated workflow to connect with …

Free Flap Reconstruction Following Head And Neck Trauma, Larissa Sweeny, Anne C. Kane, Carissa M. Thomas, Neal Futran, Joseph M. Curry, Andrés M. Bur, G. Nina Lu, Aishwarya Shukla, Hunter Skoog, Jaime A. Pena Garcia, Angela E. Alnemri, Rahul Alapati, Michael Dileo, Andrew Fuson, Kenneth Tan, Farshid Taghizadeh, Gina D. Jefferson, Daniel Petrisor, Mark K. Wax

School of Medicine Faculty Publications

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon. Methods: Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103). Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day …

Does The Use Of Double Hormone Replacement Therapy For Trauma Patient Organ Donors Improve Organ Recovery For Transplant, Eden M. Gallegos, Tanner Reed, Paige Deville, Blake Platt, Claudia Leonardi, Lillian Bellfi, Jessica Dufrene, Saad Chaudhary, John Hunt, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alan Marr, Anil Paramesh, Alison A. Smith

School of Graduate Studies Faculty Publications

BACKGROUND With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients. AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients. METHODS A retrospective review …

A Phase 3b, Open-Label, Single-Arm, Multicenter, Expanded-Access Study Of The Safety And Clinical Outcomes Of Stratagraft® Treatment In Adults With Deep Partial-Thickness Thermal Burns, James H. Holmes Iv, Angela L.F. Gibson, Tracee Short, Victor C. Joe, Jeffrey Litt, Joshua Carson, Jeffrey E. Carter, Lucy Wibbenmeyer, Helen Hahn, Janice M. Smiell, Randi Rutan, Richard Wu, Jeffrey W. Shupp

School of Medicine Faculty Publications

Background: A phase 3b, open-label, multicenter, expanded-access study (NCT04123548) evaluated safety and clinical outcomes of StrataGraft treatment in adults with deep partial-thickness thermal burns with intact dermal elements. Methods: Adult patients with 3 % to < 50 % total body surface area burns were treated with a single application of ≤ 1:1 meshed StrataGraft and followed for 24 weeks. Primary endpoint was count and percentage of patients with treatment-emergent adverse events (TEAEs). Secondary endpoints included confirmed wound closure (WC) at Week 12, durable WC at Week 24, time to WC, scar evaluation, and wound infection-related events. Results: Fifty-two patients with 96 treatment sites were enrolled. Pruritus was the most common TEAE (22 patients [42.3 %]). Twenty serious TEAEs occurred in 10 patients (19.2 %); none were related to StrataGraft. There were 4 (7.7 %) deaths (aspiration, myocardial infarction, self-injury, Gram-negative rod sepsis); none were related to StrataGraft. Confirmed WC was achieved by Week 12 in 33 patients (63.5 %; 95 % CI: 50.4–76.5 %) and 69 treatment sites (71.9 %; 95 % CI: 62.9–80.9 %). Durable WC was achieved by Week 24 in 29 patients (55.8 %; 95 % CI: 42.3–69.3 %) and 58 treatment sites (60.4 %; 95 % CI: 50.6–70.2 %). Conclusions: StrataGraft demonstrated clinical benefit. Safety data were consistent with previously reported findings.

Open Tibial Shaft Fracture Fixation Strategies: Intramedullary Nailing, External Fixation, And Plating, Michelle Shen, Nirmal Tejwani

Faculty, Staff and Student Publications

Tibial shaft fractures are one of the most common orthopaedic injuries. Open tibial shaft fractures are relatively common because of the paucity of soft tissue surrounding the bone. Despite the prevalence of these injuries, the optimal fixation strategy is still a topic of debate. The purpose of this article was to review the current literature on open tibial shaft fracture fixation strategies including intramedullary nailing, external fixation, and plating.

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Testosterone Supplementation In Patients With Burn Hypermetabolism, Alexandra Dewitt, Anastasiya Ivanko, Jonathan E. Schoen, Aimee Keating, Herb A. Phelan Iii, Jeffrey E. Carter

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Old Dog, New Tricks? Applying The Causal Hazard Chain Model To Burn Prevention And Injuries, Randy D. Kearns, Jeffrey E. Carter, Ernest Grant, W.L. Hickerson

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

The Inflammatory Response Of Patients With Major Burns And Traumatic Injuries, Jared M. Robinson, Sophia Trinh, Jenna Dennis, Cameron Fontenot, Jeffrey Hobden, Jonathan E. Schoen, Herb A. Phelan Iii, Jeffrey E. Carter, Alison A. Smith

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

When Do Patients Arrive To The Burn Center? Business Hours Don't Apply To Burns, Rohit Mittal, Kathleen Hollowed, Jeffrey E. Carter, Steven A. Kahn

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Using Implementation Science To Understand Barriers To Telemedicine Use For Burn Care During A Crisis, Amanda Bettencourt, Jeffrey E. Carter, Theresa M. Davis, Katherine R. Buhikire, Joseph Rhodes, Subhash Aryal, Gary Vercruysse, Deena Kelly-Costa, Colleen M. Ryan

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Influence Of Co-Morbid Modifiable Risk Factors On Adipose-Derived Stem Cell Paracrine Factors In Burn Patients, Jared M. Robinson, Jenna Dennis, Sophia Trinh, Cameron Fontenot, Herb A. Phelan Iii, Jeffrey E. Carter, Jonathan E. Schoen, Alison A. Smith

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Patient's Perception Of Likelihood To Attend Follow-Up In Burn Surgery Clinic, Alexandra Coward, Megan Gilbert, Anastasiya Ivanko, Jason Heard, Soman Sen, Tina L. Palmieri, David G. Greenhalgh, Kathleen S. Romanowski

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

The Burden Of Burns: An Analysis Of Public Health Measures, Anastasiya Ivanko, Anna Garbuzov, Jonathan E. Schoen, Randy S. Kearns, Denise Danos, Erica Murata, Bart D. Phillips, Herb A. Phelan Iii, Jeffrey D. Carter

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

The Consequences Of A Career In Burn Surgery: An Economic Analysis To Aid Prospective Clinicians, Jeffrey E. Carter, Anastasiya Ivanko, Jonathan E. Schoen, Herb A. Phelan Iii, William L. Hickerson, Randy D. Kearns

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

An Analysis Of Burn Icu Days From The National Injury Resource Database, Anastasiya Ivanko, Jonathan E. Schoen, William L. Hickerson, Herb A. Phelan Iii, Bart D. Phillips, Jeffery E. Carter, Denise Danos

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL

Use Of The Burn Care Quality Platform (Bcqp) For Modern Burn Care Benchmarking, Madeline G. Lechtenberg, Jeffrey E. Carter, Denise Danos, Bart D. Phillips, Erica Murata, Jonathan E. Schoen, Herb A. Phelan Iii

School of Medicine Faculty Publications

56th Annual Meeting of the American Burn Association, 2024; April 9 - April 12, 2024; Chicago, IL