Selective Operative Management of Penetrating Chest Injuries
- 25 Downloads
Purpose of Review
The aim of this review was to review the recent literature with respect to penetrating chest injuries so as to provide an update on the current/changing management of these injuries.
The management of a stable patient following penetrating chest trauma with a hemopericardium on ultrasound has changed from routine sternotomy to a pericardial window and drainage, with a sternotomy reserved for those patients who have active bleeding at the time of the pericardial window. It is imperative to diagnose and repair an occult left-sided diaphragm injury and this can be achieved laparoscopically once a hollow organ injury has been excluded. Small pneumothoraces less than 2 cm may be observed in asymptomatic patients provided the patient is not on positive pressure ventilation, and hemothoraces of less than 300 mL may be managed with observation alone.
There are new management strategies evolving in the patient presenting with penetrating thoracic trauma and it is important that surgeons managing these patients are aware of these changes.
KeywordsPenetrating chest trauma Penetrating cardiac trauma Diaphragm injuries Chest injuries Subxiphoid pericardial window Operative management chest trauma
Compliance with Ethical Guidelines
Conflicts of interest
Andrew John Nicol, Sorin Edu, and Pradeep Navsaria declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.• Nicol AJ, Navsaria PH, Beningfield S, Hommes M, Kahn D. Screening for occult penetrating cardiac injuries. Ann Surg. 2015;261(3):573–8. Ultrasound screening for a pericardial effusion after penetrating trauma can result in false positives and false negatives particularly if there is an associated hemothorax.CrossRefGoogle Scholar
- 9.• Ball CG, Williams BH, Wyrzykowski AD, et al. A caveat to the performance of pericardial ultrasound in patients with penetrating cardiac wounds. J Trauma. 2009;67:1123–4. Ultrasound screening may result in false negatives.Google Scholar
- 13.•• Nicol AJ, Navsaria PH, Hommes M, et al. Sternotomy or drainage for a hemopericardium after penetrating trauma. A randomized controlled trial. Ann Surg. 2014;259:438–42. This is the first randomized trial on stable patients with a hemopericardium after penetrating trauma and showed that simple drainage is sufficient if there is no active bleeding at the time of the procedure.CrossRefGoogle Scholar
- 20.Petrone P, Asensio JA, Marini CP. Diaphragmatic injuries and post-traumatic diaphragm hernias. Curr Probl Surg. 2017;54(11–32):88.Google Scholar
- 22.McDonald AA, Robinson BRH, Alarcon L, Dorion H, Haut ER, Juern J, Madbak F, Reddy S, Weiss P, Como JJ. Evaluation and management of traumatic diaphragmatic injuries: a practice management guideline from the East Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2018;85(1):198–207.CrossRefGoogle Scholar