One hundred and eight emergency operations for penetrating thoracic trauma.
Chest (Patient outcomes)
Chest (Care and treatment)
Chest (Demographic aspects)
|Publication:||Name: South African Journal of Surgery Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0038-2361|
|Issue:||Date: April, 2011 Source Volume: 49 Source Issue: 2|
|Topic:||Event Code: 360 Services information Canadian Subject Form: Trauma centres|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
Introduction: Penetrating thoracic trauma can usually be managed
non-operatively. In a subset of patients emergency surgical intervention
is necessary. This audit examines our experience with emergency
operation for thoracic trauma in a busy metropolitan surgical service.
Methodology: A prospective trauma registry is maintained by the Pietermaritzburg metropolitan complex. This database was retrospectively interrogated for all patients requiring an emergency thoracic operation for penetrating injury from July 2006 to July 2009. A retrospective review of mortuary data for the same period was undertaken to identify patients with penetrating thoracic trauma who had presented to the forensic mortuary.
Results: Over the 3-year period July 2006 - July 2009, a total of 1 186 patients, 77 of whom were female, were admitted to the surgical services in Pietermaritzburg with penetrating thoracic trauma. There were 124 gunshot wounds (GSWs) and 1 062 stab wounds. A total of 108 (9%) patients required emergency operation during the period under review. The mechanism of trauma in the operative group was stab wounds (102), GSWs (4), stab with compass (1) and fell on arrow (1). Over the same period 676 victims of penetrating thoracic trauma were taken to the mortuary. There were 135 GSWs (20%) of the chest in the mortuary cohort. Of the 541 stab wound victims from the mortuary cohort, there were 206 (38%) with cardiac injuries. In the emergency operation group there were 11 (10%) deaths. In 76 patients a cardiac injury was identified. The other injuries identified were lung parenchyma bleeding (12) intercostal vessels (10), great vessels of the chest (6), internal mammary vessel (2), and pericardial injury with no myocardial injury (2). Most patients reached hospital within 60 minutes of sustaining their injury. A subset of 12 patients had much longer delays of 12 - 24 hours. Surgical access was via median sternotomy in 56 patients and lateral thoracotomy in 52.
Conclusion: Less than a quarter of patients with a penetrating cardiac injury reach hospital alive. Of those who do and are operated on, about 90% will survive. Other injuries necessitating emergency operation are lung parenchyma, intercostal vessels and internal mammary vessels and great vessels of the thorax. GSWs of the thorax remain more lethal than stab wounds.
K Reddy, M Quazi, D Clarke, S Thomson
University of KwaZulu-Natal, Pietermaritzburg
|Gale Copyright:||Copyright 2011 Gale, Cengage Learning. All rights reserved.|