[Penetrating thoracic injury--seven-year experience with its diagnostics and treatment]

A retrospective analysis of seven-year follow-up results of subjects treated for penetrating thoracic injuries, aimed at optimalizing the diagnostic-therapeutic algorithm.

During 2000-2006, 39 subjects with penetrating thoracic injuries (35 males and 4 females, their mean age was 40.5 years), were diagnosed and treated in the authors' clinic. Cold weapon attacks were the commonest mechanism of the injuries (54%). The injury resulted in pneumothorax, resp. hemothorax, in, nearly, half of the subjects. The mean ISS value in the study group was 23. Less than a third of the injuried suffered associated injuries of the neck or abdominal regions. The diagnostics was based on clinical and x-ray examinations, resp. on thoracic CT.

The commonest therapeutic procedure was draining of the pleural cavity (17 subjects). In 36% of the subjects, surgical revision via thoracotomy, resp. sternotomy, was inevitable. In two subjects, miniinvasive approach sufficed. Four subjects were treated conservatively. Two patients exited immediately following their transport to hospital, no therapeutic management was possible. No other deaths following the treatment were recorded, postoperative complications occurred in 4 subjects (10%), and they, equally, required 4 reoperations.

The diagnostic process of penetrating thoracic traumas is based on clinical examination and x-ray, resp. thoracic CT. Most injuries are sufficiently managed using good quality drainage of the pleural cavity. Only few cases require urgent surgical revision via thoracotomy or sternotomy. Selected cases, mainly including stab injuries, may be successfully treated using miniinvasive techniques.