Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung

The operative management of penetrating lung injuries includes oversewing of small lung lacerations (pneumonorrhaphy), wedge resection, or anatomic resection. There are penetrating injuries of the lung for which oversewing of entrance and exit wounds will predispose to intrapulmonary hematoma or pulmonary venous-systemic air emboli, yet for which formal resection would be time consuming. The technique of pulmonary tractotomy with selective vascular ligation was developed in parallel with hepatotomy for liver injuries.

Over the past 9 years, pulmonary tractotomy has been used 18 times in 16 patients at our institution. All patients were male. Their injuries were 12 gunshot and 4 stab wounds.

There were three deaths unrelated to the tractotomy. Five surviving patients developed complications.

Pulmonary tractotomy is a straight-forward procedure that controls deep hemorrhage from lung injuries and may obviate the need for formal resection.