INDICATIONS FOR THORACOTOMY FOLLOWING PENETRATING THORACIC INJURY
作者:
ROGER SIEMENS,
HIRAM POLK,
LAMAN GRAY,
ROBERT FULTON,
期刊:
The Journal of Trauma: Injury, Infection, and Critical Care
(OVID Available online 1977)
卷期:
Volume 17,
issue 7
页码: 493-500
ISSN:0022-5282
年代: 1977
出版商: OVID
数据来源: OVID
摘要:
The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoracotomy or cardiorrhaphy following penetrating chest injury.Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission <90; 3) initial thoracostomy blood loss >800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.
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