Experience of pulmonary surgery for thoracic trauma in Iraq
ABSTRACT ObjectiveThe aim of this study was to analyze the surgical outcome of lung injuries in the Department of thoracic surgery of Alhakeem
and Alsader teaching hospital in Najaf city which drained patients from middle euphrates region of Iraq.
Patients and MethodsMedical records of 820 patients with thoracic trauma were analyzed, during the period from September 2001 to September 2007.
The analysis includes The following variables: Age and gender of patients, mechanism and scale of injury, diagnostic technique,
the performed surgical procedure, and mortality. All cases were classified according to the scale of lung injury.
ResultsMost patients were male 802 (97.8%) and only 18 (2.2%) were female, average age of the patients were 25 years (range: three
months to 70 years). The Mechanism of injury was gun shot in 315 (382.41%) patients, missiles and shell injuries in 275 (33.53%),
stabbing by knife and other similar objects in 125 patients(15.24%), and by blunt chest trauma in 105 (12.80%) patients. fourth
degree thoracic injury was the most frequent as it involved 410 patients (50.00%), followed by The Grade III in 265 (32.32%)
patients, grade II and V in 65 (7.93%) and 62 (7.56%) cases respectively, and the grade I in 18 (2.19%) cases. Ten thoracotomies
were done urgently in emergency unit and 510 thoracotomy operations in the main operating room. The most frequent surgical
technique was simple suture of injured pulmonary parenchyma as It was practiced in 432 (52.68%). The average intra-hospital
stay was seven days (range: 2 to 17 days). Mortality and morbidity were reported as (1.58%) 13 and ( 2.80%) 23 respectively.
ConclusionsTime factor in the diagnosis and specific surgical treatment in thoracic trauma were considered an important elements in decreasing
post-operative mortality and morbidity from lung injury.
SourceAvailable from: Anthony L Estrera[Show abstract] [Hide abstract]
ABSTRACT: Surgical treatment of traumatic pulmonary injuries requires knowledge of multiple approaches and operative interventions. We present a 15year experience in treatment of traumatic pulmonary injuries. We hypothesize that increased extent of lung resection correlates with higher mortality. Surgical registry data of a level 1 trauma center was retrospectively reviewed from 1984 to 1999 for traumatic lung injuries requiring operative intervention. Epidemiologic, operative, and hospital mortality data were obtained. Operative intervention for traumatic pulmonary injuries was required in 397 patients, of whom 352 (89%) were men. Penetrating trauma was seen in 371 (93%) patients. Location of the injuries was noted in the left side of the chest in 197 (50%), right side of the chest in 171 (43%), and bilateral in 29 (7%). Operative interventions included pneumonorraphy (58%), wedge resection or lobectomy in (21%), tractotomy (11%), pneumonectomy (8%), and evacuation of hematoma (2%). Overall mortality was 27%. If concomitant laparotomy was required, mortality increased to 33%. The mortality rate in the pneumonectomy group was 69.7%. The majority of lung injuries occurred in males due to penetrating trauma. Surgical treatment options ranged from simple oversewing of bleeding injury to rapid pneumonectomy. Mortality increased as the complexity of the operative intervention increased. Rapid intraoperative assessment and appropriate control of the injury is critical to the successful management of traumatic lung injury.The American Journal of Surgery 01/2004; 186(6):620-4. DOI:10.1016/j.amjsurg.2003.08.013 · 2.41 Impact Factor
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ABSTRACT: To determine the accuracy of ultrasound in the detection of pneumothorax. Prospective blinded study comparing ultrasound, CT and radiographic findings in 29 patients following 41 CT-guided lung biopsies. Ultrasound examination of the chest was limited to the biopsy needle entry site. Thirteen patients developed a post-biopsy pneumothorax demonstrated by CT. Seven of these were detected by ultrasound and six were visible on erect chest radiographs. Six of the 13 pneumothoraces were not detected by ultrasound, but five of these were loculated away from the biopsy needle entry site and were therefore in areas not examined during the limited ultrasound examination. There were no false-positive diagnoses of pneumothorax using ultrasound. The positive predictive value for ultrasound was 100% and the negative predictive value was 82%. In this patient group, ultrasound was more sensitive than erect chest radiography in the detection of pneumothorax. Both have a specificity of 100%. This study suggests that ultrasound may prove valuable in pneumothorax detection when rapid conventional radiography is not possible or practical, and in circumstances where ultrasound is readily available, such as during ultrasound-guided interventional procedures.Clinical Radiology 12/1999; 54(11):736-9. DOI:10.1016/S0009-9260(99)91175-3 · 1.66 Impact Factor
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ABSTRACT: Improved outcomes following lung injury have been reported using "lung sparing" techniques. A retrospective multicenter 4-year review of patients who underwent lung resection following injury was performed. Resections were categorized as "minor" (suture, wedge resection, tractotomy) or "major" (lobectomy or pneumonectomy). Injury severity, Abbreviated Injury Scale (AIS) score, and outcome were recorded. One hundred forty-three patients (28 blunt, 115 penetrating) underwent lung resection after sustaining an injury. Minor resections were used in 75% of cases, in patients with less severe thoracic injury (chest AIS scores "minor" 3.8 +/- 0.9 vs. "major" 4.3 +/- 0.7, p = 0.02). Mortality increased with each step of increasing complexity of the surgical technique (RR, 1.8; CI, 1.4-2.2): suture alone, 9% mortality; tractotomy, 13%; wedge resection, 30%; lobectomy, 43%; and pneumonectomy, 50%. Regression analysis demonstrated that blunt mechanism, lower blood pressure at thoracotomy, and increasing amount of the lung resection were each independently associated with mortality. Blunt traumatic lung injury has higher mortality primarily due to associated extrathoracic injuries. Major resections are required more commonly than previously reported. While "minor" resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.The Journal of trauma 01/2002; 51(6):1049-53. DOI:10.1097/00005373-200112000-00004 · 2.96 Impact Factor