Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

Abstract

BackgroundPenetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs.MethodsAll patients with PTIs admitted to a Level I Trauma Centre in France or to Role-2 facilities in war theatres between 1 January 2004 and 31 May 2016 were included. Combat casualties’ data were analysed from Role-2 medical charts. The hospital manages military casualties evacuated from war theatres who had already received primary surgical care, but also civilian patients issued from the Paris area. During the study period, French soldiers were deployed in Afghanistan, in West Africa and in the Sahelo-Saharan band since 2013.Results52 civilian and 17 military patients were included. Main mechanisms of injury were stab wounds for civilian patients, and gunshot wounds and explosive fragments for military casualties. Military patients suffered more severe injuries and needed more thoracotomies. In total, 29 (33%) patients were unstable or in cardiac arrest on admission. Thoracic surgery was performed in 38 (55%) patients (25 thoracotomies and 13 thoracoscopies). Intrahospital mortality was 18.8%.ConclusionWar PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.

Airway management in penetrating thoracic trauma

“…The mean age of patients ranged from 23.6 to 37.8 years. The most commonly seen injury mechanism was stab wound with a rate of 96.4% (Table 1) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…Demographic evaluation and pattern of injuries in patients with penetrating thoracic trauma[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] …”

A Case of Successful Combined Surgical Treatment of a Wounded With Purulous Mediastinitis After Chest and Neck Injury of Fire Origin

“…Проблема діагностики та лікування післятравматичного гнійного медіастиніту (ПГМ) висвітлена в літературі недостатньо, про що свідчать нечисленні публікації, засновані лише на вивченні невеликої кількості спостережень. Розвиток ПГМ після ВППГ у значній частині спостережень призводить до стійкої інвалідизації та летальних виходів [1][2][3][4].…”

Purulous Post-Traumatic Mediastinitis as a Complication of Flammable Penetrating Wounds of the Breast

“…Проблема діагностики та лікування післятравматичного гнійного медіастініту (ПГМ) висвітлена в літературі недостатньо, про що свідчать нечисленні публікації, засновані лише на вивченні невеликої кількості спостережень. Розвиток ПГМ після ВППГ у значній частині спостережень призводить до стійкої інвалідизації та летальних виходів [7,8].…”