Operative management of penetrating wounds of the chest in civilian practice

Oparah, Sonny S.; Mandai, Ashis K.

doi:10.1016/s0022-5223(19)40953-7

Cited by 61 publications

(6 citation statements)

References 17 publications

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“…Thoracic surgeons generally agree that most patients with penetrating wounds of the chest can be managed successfully without operation [2][3][4][5][6][11][12][13][14][15]. The proportion of those who can be treated without operation has been reported to vary from 62.1% to 91.4% [2][3][4][5][6]13]. In our series, nonoperative treatment of penetrating chest injuries was successful in 92%.…”

Section: Discussionmentioning

confidence: 51%

“…The incidence of patients with penetrating chest injuries requiring thoracotomy constitute 5.8% to 71.0% in the literature of all patients [2,6,[11][12][13][14][15][16][17][18]. Thoracotomy was required in 8.1% of our patients.…”

Section: Discussionmentioning

confidence: 70%

“…Small-caliber handgun injuries are characterized by much less primary tissue destruction than wounds caused by hunting or military weapons [10]. Thoracic surgeons generally agree that most patients with penetrating wounds of the chest can be managed successfully without operation [2][3][4][5][6][11][12][13][14][15]. The proportion of those who can be treated without operation has been reported to vary from 62.1% to 91.4% [2][3][4][5][6]13].…”

Section: Discussionmentioning

confidence: 99%

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Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

et al. 1998

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Penetrating chest injuries are a challenge to the thoracic or trauma surgeon. Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region. We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89-8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots. The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184). Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%. The mean duration of hospitalization was 11.2 days. The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome. Altogether 17% of patients with an ISS > 25 died, whereas only 0.9% of those with a score < 16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest. The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

et al. 1998

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“…In patients with thoracic trauma, the initial objective is to identify the injury as soon as possible; however, the first intervention is usually the tube thoracostomy (11)(12)(13).…”

Section: Resultsmentioning

confidence: 99%

Emergency Major Surgery in Thoracic Trauma: Timing and Decision Process

Çınar¹,

Inan²,

Yildiz³

2022

acmr

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Background: Surgery is required in 10-15% of patients with thoracic injuries. Surgery performed within the first few hours of the injury is considered as an emergency surgery. The aim of study is to share our experiences with emergency surgical approaches in thoracic trauma. Methods:Our study was carried out between June 2012-June 2020, by retrospective analysis of cases who were evaluated for thoracic trauma in the emergency department and who underwent emergency surgery.Results: There were 5784 patients who requested for thoracic surgery consultation due to thoracic trauma. Of these cases, 1317 (22.8%) were patients who were evaluated in the emergency service due to isolated thoracic trauma. There were 18 patients (1.3%) who underwent emergency surgery for isolated thoracic trauma.Glasgow score was higher in the group that was discharged after recovery among all groups; and this was statistically significant (p= 0.045). It was statistically significant that intubation and low modified trauma scores were a poor prognostic factor (respectively p= 0.035, p=0,025).Conclusions: Tube thoracostomy is sufficient for most of the thoracic traumas. After emergency evaluation, fast and correct decision in the appropriate surgical indication significantly reduces mortality.

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“…Previous studies have indicated that penetrating thoracic gunshot wounds in civilian settings can often be managed non-operatively, as they are typically associated with low-velocity bullets. This contrasts with injuries sustained in military incidents, which are usually caused by high-velocity missiles or shrapnel and often necessitate immediate open thoracotomy [ 1 - 3 ]. Immediate surgical intervention should be considered if the patient is in shock (systolic blood pressure <70 mm Hg), if the initial chest tube drainage exceeds 1,500 mL, if continuous hourly drainage surpasses 150 to 200 mL, or if injuries to mediastinal structures are suspected [ 1 , 4 - 6 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience of Surgical Treatment for Penetrating Pulmonary Gunshot Wound of a Civilian in Korea: A Case Report

et al. 2023

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Gunshot-induced chest trauma is exceedingly rare among civilians in South Korea due to strong firearm control policies. In contrast to military reports emphasizing the use of emergent open thoracotomy to increase chances of survival, most penetrating non-cardiac injuries in civilian settings are managed conservatively, such as through chest tube insertion, as they typically result from lower-energy bullets. However, early surgical intervention for penetrating gunshot wounds can help reduce delayed fatalities caused by septic complications from pneumonia or empyema. The advent of minimally invasive thoracic surgery has provided cost-effective and relatively non-invasive treatment options, aided in the prevention of potential complications from undrained hematomas, and facilitated functional recovery and reintegration into society. We successfully treated a patient with a penetrating gunshot wound to the chest using video-assisted thoracoscopic surgery.

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Operative management of penetrating wounds of the chest in civilian practice

Cited by 61 publications

References 17 publications

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

Emergency Major Surgery in Thoracic Trauma: Timing and Decision Process

Clinical Experience of Surgical Treatment for Penetrating Pulmonary Gunshot Wound of a Civilian in Korea: A Case Report

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