Keywords
blunt trauma
chest wall
surgical treatment
How to Cite
Abstract
Background: Severe thoracic trauma is the leading cause of death in the US, accounting for about 10-20 % of deaths. Causes of severe thoracic Trauma are: Penetrating trauma, Gunshot wounds, Stab wounds; Lower mortality rate, less massive, less multiorgan injury. Gunshot wounds on the chest are the most lethal, 50%. Only 7-10% undergo hospitalization prior to death. Death due to heart and significant vessel injuries.
Aim of study: Analysis of patients with Severe Thoracic Trauma, Initial Evaluation and Management analyses of our cases period 2004-2017 treated in the thoracic surgery service
Material and methods: 95 patients were treated in our hospital during the July 2004- July 2017 timeframe. The male-to-female ratio was 3:1. The Age of presentation ranged from 9 to 71 years old, with a mean age of presentation of 49 years old. Blunt chest wall trauma in 36 (38%) patients and penetrating chest wall trauma in 59 (62%) patients. Ribs and sternal fractures, two or more costal fractures in 15 (15.7%) patients (flail chest seven patients ); unilateral pneumothorax 34 (35.7%) patients, bilaterally pmeumothorax 10 (10.5%) patients; massive hemothorax 12 (12.6%) patients, pneumomediastin et subcutaneous emphysema 6 (6.31%) patients Hammans syndrome, lung contusion and parenchimal pulmonary hemathoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients, tracheal rupture 1 (1%) patient.
Results: Only medical treatment in 22 (23%) patients, unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18 (18.9%) patients; thoracotomy in 29(30.5%) patients, wedge resection, lung hemostasis and aerostasis from lung lacerations, bronchial lobar rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell incision in 1 (1%) patient; thoracoabdominal approach 2 ( 2%) patients. Flail chest wall stabilization was performed on 7 (7.3%) patients using Vicryl suture, on 3 (3%) patients using steel wire suture, and on 3 (3%) patients using a titanium plate. By VATS, 2(2.1%) patients were treated. Mean hospital stay was 11 days (average 3-36 days). Morbidity rate was observed in 6 (6.3%), and mortality occurred in 5 (5%) patients.
Conclusion: The Most common injury locations were the lung and chest wall, and less common abdominal and cranial trauma. Surgical and intensive treatment are essential, with a low mortality rate.
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