title: The pulmonary hilum twist as a thoracic damage control procedure.
abstract: BACKGROUND
  Damage control techniques have been developed and applied to abdominal, vascular and thoracic injuries. Thoracic damage control techniques must be rapid and simple.
  
  
  METHODS
  This report describes the successful use of pulmonary hilum twist as an effective damage control technique to control hemorrhage for severe lung trauma.
  
  
  RESULTS
  The procedure involves division of the inferior pulmonary ligament then anterior rotation of the lower lobe over the upper lobe. The technique can be utilized in multiple settings including the emergency center, operating room, and during resuscitation. When vascular occlusion is maintained throughout resuscitation in the intensive care unit, pneumonectomy most likely will be required, but can be performed when the physiologic parameters have improved. Complications are similar to pneumonectomy and can include right-side heart failure, dysrrythmias, and hypoxia.
  
  
  CONCLUSIONS
  Pulmonary hilar twist is an effective technique that should be considered when a damage control approach is needed.
authors.affiliation: Ben Taub General Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Wilson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Robert
authors.initials: R
authors.lastname: Maxson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mattox
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008168:Lung / Q000098:blood supply; D055370:Lung Injury; D008297:Male; D013898:Thoracic Injuries / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000601:surgery*