Penetrating cardiothoracic war wounds

• Published in: European journal of cardio-thoracic surgery Vol. 11; no. 3; pp. 399 - 405
• Main Authors: Biocina, B, Sutlić, Z, Husedzinović, I, Rudez, I, Ugljen, R, Letica, D, Slobodnjak, Z, Karadza, J, Brida, V, Vladović-Relja, T, Jelić, I
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 01-03-1997
• Subjects: Adolescent; Adult; Blast Injuries - mortality; Blast Injuries - surgery; Child; Croatia - epidemiology; Female; Heart Injuries - mortality; Heart Injuries - surgery; Humans; Lung Injury; Male; Middle Aged; Multiple Trauma - mortality; Multiple Trauma - surgery; Pneumonectomy; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - surgery; Reoperation; Survival Rate; Thoracic Injuries - mortality; Thoracic Injuries - surgery; Warfare; Wounds, Gunshot - mortality; Wounds, Gunshot - surgery; Croatia
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(96)01124-4

OBJECTIVE: Penetrating cardiothoracic war wounds are very common amongwar casualties. Those injuries require prompt and specific treatment in anaim to decrease mortality and late morbidity. There are a few controversiesabout the best modality of treatment for such injuries, and there are notmany large series of such patients in recent literature. METHODS: Weanalysed a group of 259 patients with penetrating cardiothoracic war woundsadmitted to our institutions between May 1991 and October 1992. RESULTS:There were 235 (90.7%) patients with thoracic wounds, 14 (5.4%) patientswith cardiac, wounds and in 10 (3.7%) patients both heart and lungs wereinjured. The cause of injury was shrapnel in 174 patients (67%), bullets in25 patients (9.7%), cluster bomb particles in 45 patients (17.3%) and other(blast etc.) in 15 patients (6%). Patients, 69, had concomitant injuries ofvarious organs. The initial treatment in 164 operated patients was chestdrainage in 76 (46.3%) patients, thoracotomy and suture of the lung in 71(43.2%) patients, lobectomy in 12 (7.3%) patients and pneumonectomy in 5(3%) patients. Complications include pleural empyema and/or lung abscess in20 patients (8.4%), incomplete reexpansion of the lung in 10 patients(4.2%), osteomyelitis of the rib in 5 patients (2.1%) and bronchopleuralfistula in 1 patient (0.4%). Secondary procedures were decortication in 12patients, rib resection in 5 patients, lobectomy in 2 patients,pneumonectomy in 4 patients, reconstruction of the chest wall in 2 patientsand closure of the bronchopleural fistula in 1 patient. The cardiac chamberinvolved was right ventricle in 12 patients, left ventricular in 6patients, right atrium in 7 patients, left atrium in 3 patients, ascendingaorta in 2 patients and 1 patient which involved descending aorta, rightventricle and coronary artery (left anterior descending) and inferior venacava, respectively. The primary procedure was suture in 17 patients (in 10patients with the additional suture of the lung), suture + extraction ofthe foreign body in 4 patients, 2 of them with cardiopulmonary bypass.Complications were pericardial effusion in 6 patients, arrhythmia in 2patients, myocardial infraction in 1 patient and migration of the foreignbody in 1 patient. Patients, 7, died, five of the group with concomitantinjuries, two of thoracic and one of cardiac injuries (5, 1.2 and 4.2%,respectively). CONCLUSIONS: Penetrating cardiothoracic wounds are among themost serious injuries in war, either in combat or among civilians. In spiteof their nature, they can be treated successfully with relatively lowmortality and morbidity.