Mohammad Saleem Khan, Aamir Bilal.
A prospective study of penetrating chest trauma and evaluation of role of Thoracotomy.
J Postgrad Med Inst Jan ;18(1):33-9.

Objective: To evaluate the different lines of management of penetrating chest trauma and determine the indications of thoracotomy in patients sustaining penetrating chest trauma. Material and Methods: A prospective study was conducted at the Department of Cardiothoracic Surgery; Postgraduate Medical Institute Lady Reading Hospital, Peshawar from May 1996 to April 1997. One hundred and twenty patients presenting with penetrating chest trauma were included. Those patients who had blunt chest trauma or associated injuries to the spine, abdominal viscera, head and neck and extremities were excluded from the study. All these patients were resuscitated and evaluated on arrival to the hospital. The patients were individualized on the basis of clinical parameters and grouped as stable and unstable. After haemodynamic stabilization decision regarding surgical intervention was made on the basis of clinical feature and radiological examination. In this manner patient were grouped as those requiring conservative management or surgical intervention. Results: Out of 120 patients, conservative management was adopted in 12 patients (10%). Thoracostomy tube was placed in I10 patients (91.66%). Only 12 patients (10%) underwent early Thoracotomy, 3 for massive hemothorax and lung laceration, 4 for evacuation of clotted hemothorax, 2 for removal of foreign body (bullet) in the lung parenchyma, and one each for empyema, chylothorax and diaphragmatic laceration. Two patients out of three died after emergency thoracotomy. Over all mortality was 2.5% (3 patient out of 110). Conclusion: Early thoracotomy has a definite role both in emergency situations and for various complications resulting from penetrating chest trauma. Adequate initial line of management of penetrating chest injuries will minimize life threatening complications.

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