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2020 | 3 | 1 | 66-73
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Thoracic trauma – principals of surgical management

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Thoracic trauma continues to be a significant surgical problem. It is estimated that 25% of trauma-related deaths are due to penetrating and blunt thoracic injuries. Principals of surgical management of specific thoracic injuries (tension pneumothorax, open pneumothorax, massive haemothorax, flail chest, cardiac injuries, ruptures of the aorta, tracheobronchial tree lesions, oesophageal and diaphragmatic injuries) have been reviewed. Awareness of the potential for deterioration and early correct identification of life threatening thoracic injuries are the keys to successful management. Good outcomes in the management of thoracic injuries depend on rapid transport of the injured patient to the hospital, effective diagnostic and therapeutic measures and an aggressive involvement of an experienced surgical team, optimally in the operating theatre. Successful management of these injuries depends on effective prioritisation of procedures based on the ABC principals combined with a rapid diagnosis of severe injuries and aggressive surgical treatment of life-threatening lesions following penetrating and blunt trauma. Rapid decompression of tension pneumothorax and emergency thoracotomy, especially in patients following penetrating thoracic trauma may result in good outcomes. Effective management of severe thoracic injuries requires an integrated approach and cooperation of a multidisciplinary trauma team, including experienced thoracic and cardiac surgeons.
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  • Lasek J. Krytyczna ocean przyczyn śmiertelności 681 chorych, którzy zmarli po urazie spośród 20540 osób leczonych w Katedrze i Klinice Chirurgii Urazowej AM w Gdańsku w okresie 20 lat. Rozprawa habilitacyjna. Ann Acad Medicae Gedanensis [Internet]. 2000;XXX(suppl. 3):1–307. Available from:
  • Zhang S, Tang M, Ma J, Yang J, Qin X, Jin W, et al. Thoracic trauma – a descriptive review of 4168 consecutive cases in East China. Medicine (Baltimore) [Internet]. 2019 Apr;98(14):e14993. Available from:
  • Platz JJ, Fabricant L, Norotsky M. Thoracic Trauma. Surg Clin North Am [Internet]. 2017 Aug;97(4):783–99. Available from:
  • Blyth A. Thoracic Trauma. In: Skinner D, Driskoll P, editors. ABC of major trauma [Internet]. 4th ed. Wiley-Blackwell; 2018. p. 18–28. Available from:,+4th+Edition-p-9780727918598.
  • Berg RJ, Karamanos E, Inaba K, Okoye O, Teixeira PG, Demetriades D. The persistent diagnostic challenge of thoracoabdominal stab wounds. J Trauma Acute Care Surg [Internet]. 2014 Feb;76(2):418–23. Available from:
  • Jin J, Song B, Lei Y, Leng X. Video-assisted thoracoscopic surgery for penetrating thoracic trauma. Chinese J Traumatol [Internet]. 2015 Feb;18(1):39–40. Available from:
  • Hirshberg A, Mattox KL. The Chest. In: Allen M, editor. Top knife, the art of trauma surgery [Internet]. 2005. p. 147–81. Available from:
  • Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis [Internet]. 2017 Apr;9(S3):S172–7. Available from:
  • Subcommittee A, Tchorz KM, Group IAW. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363.
  • Saillant NN, Sein V. Management of severe chest wall trauma. J Emerg Crit Care Med [Internet]. 2018 May;2:41–8. Available from:
  • Leech C. Whole body computed tomography for trauma: friend or foe? Emerg Med J [Internet]. 2017 Oct 1;34(10):635–6. Available from:
  • Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study. Landoni G, editor. PLoS One [Internet]. 2013 Jul 24;8(7):e68880. Available from:
  • Mistry N, Bleetman A, Roberts KJ. Chest decompression during the resuscitation of patients in prehospital traumatic cardiac arrest. Emerg Med J [Internet]. 2009 Oct 1;26(10):738–40. Available from:
  • Phillips B, Turco L, Mirzaie M, Fernandez C. Trauma pneumonectomy: A narrative review. Int J Surg [Internet]. 2017 Oct;46:71–4. Available from:
  • Qi Y. Clinical study on VATS combined mechanical ventilation treatment of ARDS secondary to severe chest trauma. Exp Ther Med [Internet]. 2016 Aug;12(2):1034–8. Available from:
  • Subedi N. Liver and Spleen Injuries and Associated Rib Fractures: An Autopsy Study. J Forensic Res [Internet]. 2014;5(5):240–5. Available from:
  • Pieracci FM, Majercik S, Ali-Osman F, Ang D, Doben A, Edwards JG, et al. Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury [Internet]. 2017 Feb;48(2):307–21. Available from:
  • Senekjian L, Nirula R. Rib Fracture Fixation. Crit Care Clin [Internet]. 2017 Jan 1;33(1):153–65. Available from:
  • Stranch EW, Zarzaur BL, Savage SA. Thinking outside the box: re-evaluating the approach to penetrating cardiac injuries. Eur J Trauma Emerg Surg [Internet]. 2017 Oct 18;43(5):617–22. Available from:
  • Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths. J Trauma Acute Care Surg [Internet]. 2014 Aug;77(2):213–8. Available from:
  • Sanchez GP, Peng EWK, Marks R, Sarkar PK. ‘Scoop and run’ strategy for a resuscitative sternotomy following unstable penetrating chest injury. Interact Cardiovasc Thorac Surg [Internet]. 2010 Mar 1;10(3):467–8. Available from:
  • Watanabe K, Fukuda I, Asari Y. Management of traumatic aortic rupture. Surg Today [Internet]. 2013 Dec 23;43(12):1339–46. Available from:
  • Karmy-Jones R, Jackson N, Long W, Simeone A. Current Management of Traumatic Rupture of the Descending Thoracic Aorta. Curr Cardiol Rev [Internet]. 2009 Aug 1;5(3):187–95. Available from:
  • Madden BP. Evolutional trends in the management of tracheal and bronchial injuries. J Thorac Dis [Internet]. 2017 Jan;9(1):E67–70. Available from:
  • McDonald AA, Robinson BRH, Alarcon L, Bosarge PL, Dorion H, Haut ER, et al. Evaluation and management of traumatic diaphragmatic injuries. J Trauma Acute Care Surg [Internet]. 2018 Jul;85(1):198–207. Available from:
  • Mizobuchi T, Iwai N, Kohno H, Okada N, Yoshioka T, Ebana H. Delayed diagnosis of traumatic diaphragmatic rupture. Gen Thorac Cardiovasc Surg [Internet]. 2009 Aug 24;57(8):430–2. Available from:
  • Bouillon B, Probst C, Maegele M, Wafaisade A, Helm P, Mutschler M, et al. Schockraummanagement Polytrauma. Der Chir [Internet]. 2013 Sep 28;84(9):745–52. Available from:
  • Boddaert G, Hornez E, De Lesquen H, Avramenko A, Grand B, MacBride T, et al. Resuscitation thoracotomy. J Visc Surg [Internet]. 2017 Dec;154:S35–41. Available from:
  • Mollberg NM, Tabachnik D, Farjah F, Lin F-J, Vafa A, Abdelhady K, et al. Utilization of Cardiothoracic Surgeons for Operative Penetrating Thoracic Trauma and Its Impact on Clinical Outcomes. Ann Thorac Surg [Internet]. 2013 Aug;96(2):445–50. Available from:
  • Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center. Injury [Internet]. 2011 Sep;42(9):900–4. Available from:
  • Seamon MJ, Haut ER, Van Arendonk K, Barbosa RR, Chiu WC, Dente CJ, et al. An evidence-based approach to patient selection for emergency department thoracotomy. J Trauma Acute Care Surg [Internet]. 2015 Jul;79(1):159–73. Available from:
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