Lung-Sparing Surgery After Penetrating Trauma Using Tractotomy, Partial Lobectomy, and Pneumonorrhaphy

Abstract

To evaluate the role of lung-sparing surgical techniques in the surgical management of penetrating pulmonary injuries.Design: Retrospective case series.Setting: Academic level I trauma center.Patients and Methods: Forty patients underwent thoracic surgery for penetrating lung injuries during a 63month period from January 1993 to March 1997. Five (12.5%) underwent anatomical lobectomy, 3 (7.5%) pneumonorrhaphy, 9 (22.5%) stapled wedge resection, and 23 (57.5%) stapled tractotomy. In total, 34 patients (85%) were treated with stapling techniques (1 anatomical lobectomy, 1 pneumonorrhaphy, 9 stapled wedge resections, and 23 stapled tractotomies) and 35 (87.5%) underwent had lung-sparing surgery for trauma.Results: Morbidity and mortality rates were 40% and 5%, respectively. Patients who underwent anatomical lobectomy required longer mechanical ventilatory support, intensive care unit stay, and hospital stay and had a higher morbidity rate compared with patients who underwent lung-sparing surgery for trauma but had central and extensive pulmonary injuries. Stapled tractotomy was efficient in controlling bleeding and bronchial leaks, but, in 3 patients, parts of the divided lung parenchyma were devascularized and had to be resected.Conclusions: Lung-sparing surgery for trauma with the use of staplers can be used in the majority of patients with penetrating pulmonary injuries requiring operation. Stapled tractotomy is a rapid and effective method for controlling hemorrhage and air leaks.

Urgent pulmonary lobectomy for blunt chest trauma: report of three cases without mortality

“…Consequently, pneumonorrhaphy and tractotomy are the surgical techniques preferred in chest trauma (7,9). Pulmonary resections are needed in 17% of patients that underwent urgent thoracotomy for blunt chest trauma and range from wedge resection to pneumonectomy (5).…”

Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review

“…Therefore only the traumatic damaged pulmonary segments should be disconnected specifically. Because of the direct correlation with the lethality rate the dimension of pulmonary resection should be strictly limited [25,50,57,66,69,70]. Sagittal perforations are provided by a so called " Tractotomy", which means the perforation canal is opened by a linear cutter to sew selectively opened bronchial tubes and blood vessels [25,30,57,69,70].…”

Operative Management of Lung Injuries

“…An approach that has become the Bstandard^in the past two decades is to preserve as much lung as possible using pulmonary tractotomy or limited non-anatomic lung resections in order to accomplish the two goals mentioned above [16,21,22]. This approach should not be construed as a mandate to save pulmonary parenchyma at the expense of rapidly controlling bleeding.…”