The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

Optimized brake-based control of path lateral deviation for mitigation of secondary collisions

This paper considers brake-based lateral control of a passenger vehicle, for reducing secondary collision risk following an initial impact in a traffic accident. Since secondary collisions are associated with deviations from the original travel path, the control problem is formulated via brake control sequences that minimize lateral path deviation. Optimal sequences are found not to conform to any simple control mode; sometimes all brakes are released, sometimes all wheels are locked, or the brakes may be applied in differential mode. In general, the optimal strategy combines several such actuation modes, and analysis shows it is related to the utilization of instantaneous vehicle force and moment capacity, indicating that a closed-loop control strategy may be developed based on the real-time estimation of tyre force limits during the post-impact event. Yaw motion control is related to response discontinuity and multiple equilibria found in the optimal response - a small change in initial yaw velocity generates large changes in the ensuing vehicle motion and thus in the aimed equilibrium point of the vehicle's orientation. Overall it is found that braking control strongly influences the post-impact path of the impacted vehicle, and may therefore form the basis of a practical system for avoiding secondary collisions in future traffic accidents. © Authors 2011

EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen.

To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used