Aggressive arterial reconstruction for critical lower limb ischaemia

✍ Scribed by P. R. F. Bell; N. J. M. London; M. H. Simms; N. C. Hickey

• Publisher: John Wiley and Sons
• Year: 1992
• Tongue: English
• Weight: 140 KB
• Volume: 79
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800790763

✦ Synopsis

Correspondence

1. 'One dose (of antibiotics) before operation should be followed by two doses thereafter unless there is colonic injury, in which case a therapeutic course for 5 days should be used.' This suggestion does not reflect the state of the art. Currently, most trauma surgeons do not recommend antibiotic therapy beyond 48 h after colonic injury'. In fact, when contamination is minimal, a short perioperative course is satisfactory.

2. 'Some suggest splenic preservation (during distal pancreatectomy), but this involves a tedious dissection and added time, which could be considered inappropriate in an acute situation.' This is not true: using Warshaw's manoeuvre*, tedious and time-consuming dissection of the pancreas off the splenic vessels is no longer necessary. Instead the pancreas is separated from the spleen by dividing the splenic artery and vein distal to the pancreatic tail, allowing the spleen to survive on the short gastric vessels. The latter are carefully preserved by staying away from the splenic hilum.

3. The authors dogmatically endorse the use of sump drains which 'should always be used'. Recent articles that question the superiority of these drains in pancreatic trauma are not stated, and topics such as the two-stage pancreaticoduodenectomy and pancreatic 'sequestrum' formation are not mentioned.