Surgical management of penetrating pulmonary injuries

Abstract

Chest injuries were reported as early as 3000 BC in the Edwin Smith Surgical Papyrus. Ancient Greek chronicles reveal that they had anatomic knowledge of the thoracic structures. Even in the ancient world, most of the therapeutic modalities for chest wounds and traumatic pulmonary injuries were developed during wartime.The majority of lung injuries can be managed non-operatively, but pulmonary injuries that require operative surgical intervention can be quite challenging. Recent progress in treating severe pulmonary injuries has relied on finding shorter and simpler lung-sparing techniques. The applicability of stapled pulmonary tractotomy was confirmed as a safe and valuable procedure. Advancement in technology have revolutionized thoracic surgery and ushered in the era of videoassisted thoracoscopic surgery (VATS), providing an alternative method for accurate and direct evaluation of the lung parenchyma, mediastinum, and diaphragmatic injuries.The aim of this article is to describe the incidence of the penetrating pulmonary injuries, the ultimate techniques used in its operative management, as well as the diagnosis, complications, and morbidity and mortality.

Patterns of Chest Injuries among Yemeni Patients: a Retrospective Analysis

“…In the present study, the management modalities correlate with those reported in the literature (16,17). Most penetrating chest injuries do not require major operative interventions, and several patients are managed with observation and serial evaluation using radiography or simple tube thoracostomy (11).…”

“…Gunshot wounds represent the major penetrating mechanism of injury for patients requiring thoracotomy, ranging from 13% to 70% of the cases (9,16,17), as opposed to less than 10% of injuries from blunt chest trauma. On the other hand, the present study found that early thoracotomy was performed in 26.0% of penetrating injuries and in 2.8% of blunt injuries.…”

Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients

“…Thoracic DC interventions Pneumonorrhaphy 1,7,8 After small injured vessels and bronchi within the parenchyma of a superficial pulmonary laceration are selectively ligated, the edges are approximated. Pulmonary tractotomy 1, 7Y10 The lung bridging a pulmonary parenchymal wound is divided using a GIA 55/75 vascular stapler or between two long vascular clamps and then small injured parenchymal vessels and bronchi lying underneath are selectively ligated.…”

The Lungs

“…It does require more extensive preparation. It should only be utilized if the patient is hemodynamically stable, and the injury is confined to a single hemithorax [ 8 ]. Correct positioning of the patient is essential and includes lateral positioning with the iliac crest at the level of the table break and rolls or an inflated bean bag to assist in stabilization.…”