Penetrating Wounds of the Torso

Abstract

Penetrating trauma is on the increase as a result of interpersonal violence throughout the world. It is essential that military surgeons are familiar with such injuries and trained not only in the principles of their management, but also have first-hand operative experience before deployment in the field of conflict. More often than not, this experience is to be gained in the civilian urban setting in countries such as South Africa and the USA.The article addresses the first requirement -the principles of managementand outlines basic measures to enable those unfamiliar with penetrating wounds of the torso to make a reasonable and directed approach to dealing with these patients. It does not attempt to give definitive advice on specific injuries.It is organised according to anatomical regions, but emphasises that this is only in order to put shape to the article; penetrating injuries frequently having no respect for anatomical boundaries. Particular attention is drawn to difficult areas such as mediastinal injuries, and to modern concepts of 'damage control' surgery and the 'abdominal compartment syndrome'. The emphasis throughout is on how to get out of trouble and where particular danger spots may be anticipated. Reference will be made to the differences that may be expected within the military environment as opposed to the civilian setting, where rapid and (usually) safe evacuation to a well-equipped secure facility may not be possible.The article aims to raise the awareness of those involved in the care of patients with penetrating wounds of the torso that a methodical approach with a practised team of experienced individuals can salvage injuries which at first sight may seem terrifying or hopeless.

Abdominal trauma in a semi-urban tertiary health institution

“…Four patients with stab abdominal injury and one with gunshot wound to the right upper quadrant benefited from SNOM with satisfactory outcome. This further supports the growing trend in moving away from routine exploratory laparotomy to SNOM in both blunt and penetrating injuries encapsulated in the aphorism that "not everybody with a 'hole' in the abdomen needs exploration" (8,9). Splenectomy (38.3%) was the commonest surgical procedure performed for splenic injury in this study.…”

“…There has been a paradigm shift from routine operative to selective non-operative management (SNOM) of both blunt and penetrating injuries over the years. The present maxim for penetrating injury is that "not everybody with a hole in the abdomen needs exploration" unlike before when routine laparotomies were required in all patients (8,9). We conducted this study in our setting to know the incidence of abdominal trauma, evaluate the pattern of abdominal injuries, patient characteristics and the management outcome.…”

Penetrating Abdominal Trauma: Experience in A Teaching Hospital, Calabar, Southern Nigeria

“…In 1960, Shaftan suggested selective management of patients with abdominal stab wound after observing an increased rate of laparotomy without identifiable injuries [2]. Recently several studies have favored a more conservative approach as opposed to mandatory exploratory laparotomy [7,8]. More recently, expectant management has been used in the treatment of specific GSW's to the abdomen [2,3].…”

Penetrating injuries to the pelvis

“…Isolierte Verletzungen von rektal und vaginal her führen zu Perforationen, die nicht sofort ersichtlich sind. Eine systematische Herangehensweise mit festgelegten Untersuchungsgang vermag die Frequenz übersehener Verletzungen zu senken [2].…”