[Pneumothorax and haemothorax (author's transl)]

Pneumothorax and haemothorax constitute serious complications of a blunt chest trauma. During 1970-1978 64 persons with pneumothorax and 109 cases of haemothorax were admitted to and treated in the Surgical Unit of the University Hospital, Göttingen. In nearly every case fracture of several ribs had also occurred. The method of choice for treating cases of pneumothorax was by Bülau drainage; surgical closure of the air leakage was rarely necessary. Conservative measures are indicated only if the pneumothorax is narrow or confined to the apical region. It is worth mentioning that in a large number of cases pneumothorax developed during positive pressure ventilation after a chest injury. Complications of Bülau drainage were: damage to the lungs, skin emphysema and bleeding from the intercostal artery. Open application of the Bülau drainage in the 2nd intercostal space is therefore recommended. Treatment of traumatic pleural effusions by Bülau drainage was required in only 14 of 109 cases. Therapy-resistent effusions necessitated thoracotomy and evacuation of the haematoma in 4 persons. If Bülau drainage fails completely to evacuate the haemothorax, it should be promptly followed by thoracotomy to prevent the development of adhesions and the resulting impairment of respiratory function.