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Damage-control thoracic surgery: Management and outcomes.

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    Damage-control thoracic surgery is effective for severe chest trauma, improving patient physiology before definitive closure. This approach, using thoracic packing and vacuum closure, offers acceptable mortality for critically injured patients.

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    Area of Science:

    • Trauma Surgery
    • Thoracic Surgery
    • Surgical Critical Care

    Background:

    • Damage-control surgery (DCS) is established for abdominal trauma but understudied for thoracic injuries.
    • Severe thoracic trauma often presents with significant physiologic derangement, necessitating innovative surgical approaches.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of damage-control thoracic surgery (DCTS) in patients with severe thoracic trauma.
    • To assess the role of thoracic packing and temporary vacuum-assisted closure in managing these complex injuries.

    Main Methods:

    • Retrospective analysis of a trauma registry (2002-2012) of patients undergoing emergency thoracotomy/sternotomy with temporary closure.
    • Data collected included demographics, injury severity (ISS, AIS), physiologic parameters, operative procedures, and outcomes.
    • Statistical analysis used Student's t test; p < 0.05 was considered significant.

    Main Results:

    • Forty-four severely injured patients (ISS 33.2) with high chest AIS scores underwent DCTS.
    • Common procedures included pulmonary resection (73%) and thoracic packing with vacuum-assisted closure (95%).
    • Physiologic parameters significantly improved from initial operation to chest closure (p < 0.001). Mortality was 23%, with higher ISS predicting worse outcomes.

    Conclusions:

    • Damage-control thoracic surgery is a viable option for severely injured patients with significant physiologic derangement.
    • Thoracic packing and temporary vacuum closure effectively manage the thorax, preventing compartment syndrome.
    • Chest closure timing should be guided by physiological normalization, and while complications are frequent, outcomes are acceptable given injury severity.