Penetrating Wounds of the Heart

Ac, Beall; Ta, Patrick; Je, Okies; Dl, Bricker; Me, Debakey

doi:10.1097/00005373-197206000-00003

Cited by 74 publications

(2 citation statements)

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“…The incision juxtaposition was articulated by Arthur Beall Jr, a prolific authority on chest trauma who wrote, ''Generally, median sternotomy incisions have not been used [in trauma] due to the difficulties encountered in obtaining exposure of the dorsal surface of the heart and the posterior mediastinal structures [18].'' Numerous papers by Beall and colleagues at Houston's Ben Taub Hospital from 1960-1972 addressed penetrating thoracic trauma, which influenced a paradigm shift toward more liberal use of emergency thoracotomy [19]. Their primary goal was identifying candidates for emergency thoracotomy and performing these interventions rapidly, often at bedside, which ultimately reduced mortality risk compared to more conservative measures like pericardiocentesis.…”

Section: Clamshell Incision Origins and Evolutionmentioning

confidence: 99%

Historical Observations on Clamshell Thoracotomy

et al. 2021

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Bilateral transverse thoracosternotomy, known colloquially as “clamshell thoracotomy,” provides quick and extensive exposure to the thoracic organs. The origins of the radical incision are unclear, and its influence on historical developments in surgery has not been elaborated. Transsternal extension to bilateral thoracotomy likely occurred during World War I and was designated as Tuffier's method by 1922. Théodore Tuffier had already solidified his reputation as a trailblazing thoracic surgeon in Paris when the French army summoned him to design triage systems for trauma patients during the Great War. Following World War II, cardiac surgery grew tremendously during the 1950s, and many pioneering open‐heart procedures utilized the bilateral incision for safe exposures with satisfactory results. Median sternotomy became the incision of choice for open‐heart surgery by the early 1960s; however, thoracotomy remained important to the trauma surgeon's repertoire. Transsternal conversion was only briefly mentioned in trauma literature through the 1980s, although up to one‐half of reported emergency thoracotomies at busy trauma centers were clamshells. The moniker clamshell thoracotomy came in 1994 when thoracic surgical oncology and lung transplantation flourished with complex operations requiring larger incisions. The twenty‐first century has brought two iterations of evidence‐based guidelines for emergency thoracotomy, but incision choice has not been formally discussed. Renewed conversation in recent years has advocated for the clamshell as arguably the best approach for patients in extremis. Given these trends, the tortuous history of this controversial incision deserves attention.

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Section: Clamshell Incision Origins and Evolutionmentioning

confidence: 99%

Historical Observations on Clamshell Thoracotomy

et al. 2021

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“…The work of Blalock and Ravitch (6), who advocated emergency pericardiocentesis, has considerably influenced the approach of generations of surgeons since 1943. In the more recent literature (1,2,3,5,7,8,11,15,16,17,18,19,20) there is a clear tendency away from the more conservative plan of management to early and more aggressive surgical intervention. Even today, "a penetrating wound of the pericardium and the heart is one of the most dramatic and potentially demanding emergencies that a "surgeon has to manage" (2).…”

mentioning

confidence: 99%

Penetrating Wounds of the Heart and Pericardium

Radtke¹,

Lubbe²,

Jansön³

et al. 1979

Thorac cardiovasc Surg

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Fifty-seven patients with penetrating cardiac or pericardial trauma were treated at the Department of Cardio-Thoracic Surgery, University of Stellenbosch at the Tygerberg Hospital during a 6 1/2 year period from June 1971 to January 1978. Eleven patients were treated by aspiration alone because tamponade was mild, or because they were seen between 24 hours and 3 weeks after injury. Six patients underwent late elective surgery. Cardiopulmonary bypass had to be employed in four patients to correct intracardiac lesions. All other patients underwent emergency operations 8 minutes to 2 hours after admission to hospital. The hospital mortality was 4 of 57 patients (7%), lower than rates reported in other series. Some selected cases will be described more fully and our present plan of management is outlined.

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Unusual Manifestations of Penetrating Cardiac Injuries

M¹

1975

Arch Surg

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Penetrating Wounds of the Heart

Cited by 74 publications

References 0 publications

Historical Observations on Clamshell Thoracotomy

Historical Observations on Clamshell Thoracotomy

Penetrating Wounds of the Heart and Pericardium

Unusual Manifestations of Penetrating Cardiac Injuries

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