Operative Management of Thoracic Gunshot Wounds: More Aggressive Treatment Has Been Required over Time

Abstract

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as “historical” (1973–1975 and 1988–1990) and “modern” (2005–2007 and 2015–2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.

Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report

“…It is worth to mention that injuries to the left half of the chest and supraclavicular area are the most dangerous, due to the location of such vital organs and structures as the brain, heart, aorta, carotid arteries, jugular veins, etc. , which may lead to significant mortality in pre-hospital (up to 27 %) and hospital stages - 12.2 - 25 % [5] . The aim of this study was to demonstrate a rare case of unusual localization of the bullet in the neck after the gunshot injury to the chest and arm as well as to emphasize the utility to perform whole-body visualization techniques for a patient with a gunshot injury.…”

National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US

“…This finding is consistent with previous studies, as a disproportionate amount for firearm-related injuries are a result of interpersonal violence. [36][37][38] The current study has several important limitations. First, the data elements analyzed were based on coding and might be subject to variations in practice.…”

Chronic pain in patients with mine-explosive wounds

“…Chronic pain is a serious problem that requires even more attention during wartime, because the number of pathologies caused by mine-explosive devices has increased signi cantly over the past ten years [2,4,5,10,11,12]. Such an injury must be considered as a multifactorial injury resulting from a combined impact on a person, therefore the pain in such patients is special [3,7,8,9,14].…”