[Penetrating chest injuries--an indication for early thoracotomy]

Indication for thoracotomy is undisputed in cases of gaping wounds with massive haemorrhage. However, discrete stab and gunshot wounds may quite often conceal imminent pericardial tamponade. Three quarters of all penetrating thorax injuries are located in or close to the cardiac silhouette. When it comes to patients with circulatory conditions of good stability, management of superficial wounds may cost valuable time and cause delay to thorough revision of the cardiac injury which usually would be possible without extracorporeal circulation. Success of that revision may then be limited due to tamponade-related impairment of cerebral perfusion and subsequent ischaemic brain damage. The risk implied in early exploratory thoracotomy was found to be low, as compared to the risk emanating from pericardial tamponade in cases of stab wounds in the cardiac region. Hence, early thoracotomy is generally indicated and should be generously decided to handle penetrating wounds of the chest. Superiority of early thoracotomy in handling penetrating thorax injuries is demonstrated in this paper by six of the authors' own patients. While relief of cardiac tamponade is possible by pericardiocentesis, immediate and safe restoration of blood volume through a central vein or the right atrium, control of haemorrhage, and definite repair of the cardiac defect can be achieved only by thoracotomy.