Penetrating wounds of the torso

Penetrating trauma is on the increase as a result of interpersonal violence throughout the world. It is essential that military surgeons are familiar with such injuries and trained not only in the principles of their management, but also have first-hand operative experience before deployment in the field of conflict. More often than not, this experience is to be gained in the civilian urban setting in countries such as South Africa and the USA. The article addresses the first requirement--the principles of management--and outlines basic measures to enable those unfamiliar with penetrating wounds of the torso to make a reasonable and directed approach to dealing with these patients. It does not attempt to give definitive advice on specific injuries. It is organised according to anatomical regions, but emphasises that this is only in order to put shape to the article; penetrating injuries frequently having no respect for anatomical boundaries. Particular attention is drawn to difficult areas such as mediastinal injuries, and to modern concepts of 'damage control' surgery and the 'abdominal compartment syndrome'. The emphasis throughout is on how to get out of trouble and where particular danger spots may be anticipated. Reference will be made to the differences that may be expected within the military environment as opposed to the civilian setting, where rapid and (usually) safe evacuation to a well-equipped secure facility may not be possible. The article aims to raise the awareness of those involved in the care of patients with penetrating wounds of the torso that a methodical approach with a practised team of experienced individuals can salvage injuries which at first sight may seem terrifying or hopeless.