Body wall thickness in adults and children--relevance to penetrating trauma.
OBJECTIVE
Although uncommon in children, penetrating trauma may be associated with considerable risk of morbidity and mortality. In part this reflects the child's thinner body wall. No data exists on the difference in body wall thickness in children as compared to adults.


METHODS
Computer tomography (CT) scans (23 adults and 17 children) selected at random were reviewed. Measurements of the thickness of the skin and subcutaneous tissue were taken from anatomically defined regions on the thoracic and abdominal wall. The differences between adults and children were compared and analysed statistically.


RESULTS
The mean ages were 51.3 years for an adult and 8.9 years for a child. Indications for the CT scans included malignancy, inflammatory conditions and blunt trauma. Statistically significant differences in the median thicknesses of adult and paediatric thoraco-abdominal wall were found in all of the regions measured. This difference ranged from 7 mm at the xiphisternum to 14 mm in the right and left axillary lines at the level of the iliac crests.


CONCLUSIONS
The demonstrated difference in thickness of the thoraco-abdominal wall of an adult as compared to a child means that for a penetrating injury of equal depth, the body wall will be more easily breached and more organs potentially damaged in a child, particularly if the injury is sustained in the flanks. This supports the principle that all penetrating thoraco-abdominal wounds in children should be explored in the operating theatre under general anaesthesia to reduce the risk of a missed injury.
Sandler
Gideon
G
The University of Sydney, Department of Academic Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, 2145, Australia. gidsandler@gmail.com
Leishman
Sarah
S
Branson
Helen
H
Buchan
Craig
C
Holland
Andrew J A
AJ
D034861:Abdominal Wall / Q000033:anatomy & histology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D035441:Thoracic Wall / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D055815:Young Adult