Thoracotomy for chest trauma: Indication, operative finding, and outcome

Abstract

Background: To evaluate indication and result of open posterolateral thoracotomy done in the theatre for chest trauma (CT). Methods: During a 5-year period, our team performed thoracotomies in a total of 24 patients out of the 307 patients who had CT. The demographic data, type, mechanism, clinical diagnoses, operative finding, Injury Severity Score, case-fatality rate, and complication of the CT were computed with the descriptive statistics were presented in percentage and fraction. All the surgeries were performed by the same team. Results: Of the 307 patients who sustained CT, 24 patients (7.8%) had open posterolateral thoracotomy done in the theater. The mean age was 31.2 (standard deviation ± 13.10) years with a male-to-female ratio of 7:1. The cause of CT was gunshot injury 13 (54.2%) patients, motor vehicular accident in 5 (20.8%) patients, stab injury in 5 (20.8%) patients, and fall 1 (4.2%) patient. The diagnosis was made following the assessment of the quantity and quality of the output of inserted chest tube, auscultated bowel sounds in the chest, chest radiograph, and chest ultrasound. The operative finding was diaphragmatic injury in 13 patients (54.2%), lung laceration in 5 patients (20.8%), negative in two patients (8.3%), bullet in the pleural space in two patients (8.3%), and trachea-bronchial injury and bleeding internal mammary artery (4.2%) in a patient each. The case-fatality rate was 17.4%. Conclusion: Massive hemothorax remains the most common reason for the thoracotomy with diaphragmatic injury being the most common intraoperative finding. Diaphragmatic rupture should be ruled out before the insertion of chest tube for traumatic hemothorax or pneumothorax.