Wounds of the Chest in War and Peace

Brewer, Lyman A.

doi:10.1016/s0003-4975(10)66202-9

Cited by 27 publications

(3 citation statements)

References 8 publications

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“…The Great War transformed emergency thoracic surgery, exposing the benefits and complications, which arose from surgical chest exploration. Lord Moynihan from the British Army and Pierre Duval of the French army were staunch supporters of thoracotomy [6]. The onset of war paralleled developments in surgical instrumentation, a prime invention being The ´odore Tuffier's self-retaining rack-and-pinion rib spreader in 1914 [7].…”

Section: Clamshell Incision Origins and Evolutionmentioning

confidence: 99%

Historical Observations on Clamshell Thoracotomy

et al. 2021

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Bilateral transverse thoracosternotomy, known colloquially as “clamshell thoracotomy,” provides quick and extensive exposure to the thoracic organs. The origins of the radical incision are unclear, and its influence on historical developments in surgery has not been elaborated. Transsternal extension to bilateral thoracotomy likely occurred during World War I and was designated as Tuffier's method by 1922. Théodore Tuffier had already solidified his reputation as a trailblazing thoracic surgeon in Paris when the French army summoned him to design triage systems for trauma patients during the Great War. Following World War II, cardiac surgery grew tremendously during the 1950s, and many pioneering open‐heart procedures utilized the bilateral incision for safe exposures with satisfactory results. Median sternotomy became the incision of choice for open‐heart surgery by the early 1960s; however, thoracotomy remained important to the trauma surgeon's repertoire. Transsternal conversion was only briefly mentioned in trauma literature through the 1980s, although up to one‐half of reported emergency thoracotomies at busy trauma centers were clamshells. The moniker clamshell thoracotomy came in 1994 when thoracic surgical oncology and lung transplantation flourished with complex operations requiring larger incisions. The twenty‐first century has brought two iterations of evidence‐based guidelines for emergency thoracotomy, but incision choice has not been formally discussed. Renewed conversation in recent years has advocated for the clamshell as arguably the best approach for patients in extremis. Given these trends, the tortuous history of this controversial incision deserves attention.

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Section: Clamshell Incision Origins and Evolutionmentioning

confidence: 99%

Historical Observations on Clamshell Thoracotomy

et al. 2021

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“…The mortality rate is considerable, especially when a tension pneumothorax develops from air trapped in the intrapleural cavity. 2 Stiles and colleagues 3 described the performance of tactical casualty care interventions by law enforcement personnel in the state of Wisconsin. In 7 of 70 interventions a chest seal (CS) was established.…”

mentioning

confidence: 99%

Rescue Blanket as a Provisional Seal for Penetrating Chest Wounds in a New Ex Vivo Porcine Model

Schachner

Isser

Haselbacher

et al. 2022

The Annals of Thoracic Surgery

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BACKGROUND Open pneumothorax after a penetrating thorax trauma is a life-threatening disease with high mortality.An emergency application of a chest seal (CS) allowing the release of trapped air is the optimum initial therapy until surgical chest drainage is available.METHODS In a newly developed experimental porcine model of open pneumothorax, we tested 3 different materials regarding their applicability for acute treatment of sucking chest wounds in prehospital emergency care, namely a commonly used rescue blanket (RB), plastic foil from a gauze package (packing material), and a commercial CS. RESULTSAn ex vivo open pneumothorax model using a porcine chest wall and a vacuum-assisted drainage system was successfully established. RB segments sized 70 3 100 mm achieved significantly higher rates of successful sealing than plastic foils from a gauze package sized 100 3 100 mm when the devices were applied to the moistened chest wall and fixed on 3 sides (5/5 [100%] vs 0/5 [0%], respectively; P [ .002). Loosely fixed RBs efficiently released injected air (10/10 [100%]) and consequently sealed the wound in all cases (10/10).CONCLUSIONS RBs, applied wet, are appropriate CSs with good occlusive and adherence properties. Fixation on 2 sides of the dressing is sufficient to allow trapped air to exit while providing appropriate sealing of the chest wound. RBs were superior to plastic foils from a gauze package and were seen to function as a potent makeshift CS when no commercial CS is available.

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“…The first application of non-invasive positive airway pressure in the treatment of a patient with chest injuries was reported by Lyman A. Brewer III in 1944, in Cassino, Italy, during World War II, using a portable anaesthetic machine and a face mask [5]. Subsequently, starting in the early 1980s, several studies on the treatment of trauma patients were conducted.…”

mentioning

confidence: 99%