Surgical management of penetrating pulmonary injuries

Abstract

Chest injuries were reported as early as 3000 BC in the Edwin Smith Surgical Papyrus. Ancient Greek chronicles reveal that they had anatomic knowledge of the thoracic structures. Even in the ancient world, most of the therapeutic modalities for chest wounds and traumatic pulmonary injuries were developed during wartime. The majority of lung injuries can be managed non-operatively, but pulmonary injuries that require operative surgical intervention can be quite challenging. Recent progress in treating severe pulmonary injuries has relied on finding shorter and simpler lung-sparing techniques. The applicability of stapled pulmonary tractotomy was confirmed as a safe and valuable procedure. Advancement in technology have revolutionized thoracic surgery and ushered in the era of video-assisted thoracoscopic surgery (VATS), providing an alternative method for accurate and direct evaluation of the lung parenchyma, mediastinum, and diaphragmatic injuries. The aim of this article is to describe the incidence of the penetrating pulmonary injuries, the ultimate techniques used in its operative management, as well as the diagnosis, complications, and morbidity and mortality.

Figure 1

Thoracic instrument tray.

Figure 2

Duval lung forceps.

Figure 3

Double lumen endotracheal tubes.

Figure 4

Depicts the cavitary effect created by a missile traversing the lung. Stapling device is placed through the orifices of entry and exit wounds.

Figure 5

Stapling device is closed and fired to create the tractotomy.

Figure 6

The tract is open and the deep bleeding vessels are selectively ligated.