Chest Wall and Diaphragm Injury

Abstract

Despite improvements in body armor, chest wall injuries are still common enough in combat settings that the surgeon must have more than passing familiarity with the management of them. The injuries can range from simple rib fractures, which every general surgeon has dealt with multiple times by the end of residency, to massive tissue and rib loss with eviscerated and injured lung, scapula or shoulder girdle involvement, hemorrhage, and open pneumothorax (Fig. 17.1). The vast majority of chest wall injuries can be temporized with damage control measures until other pressing injuries and physiologic needs can be addressed and stabilized. The reconstruction of chest wall defects from tissue loss can and should be delayed until the patient is evacuated to higher echelons of care, or at least until hemorrhage is well controlled, the patient resuscitated, and contamination/infection cleared up.

Deployment Experience:

Alec C. Beekley Staff Surgeon, 102nd Forward Surgical Team, Kandahar Airfield, Afghanistan, 2002–2003

Chief of Surgery, 912th Forward Surgical Team, Al Mussayib, Iraq, 2004

Staff Surgeon, 31st Combat Support Hospital, Baghdad, Iraq, 2004

Director, Deployed Combat Casualty Research Team, 28th Combat Support Hospital, Baghdad, Iraq, 2007