The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma.
OBJECTIVE
Retained haemothorax and pneumothorax are the most common complications after blunt chest traumas. Lung lacerations derived from fractures of the ribs are usually found in these patients. Video-assisted thoracoscopic surgery (VATS) is usually used as a routine procedure in the treatment of retained pleural collections. The objective of this study was to find out if there is any advantage in adding the procedure for repairing lacerated lungs during VATS.


METHODS
Patients who were brought to our hospital with blunt chest trauma were enrolled into this prospective cohort study from January 2004 to December 2011. All enrolled patients had rib fractures with type III lung lacerations diagnosed by CT scans. They sustained retained pleural collections and surgical drainage was indicated. On one group, only evacuation procedure by VATS was performed. On the other group, not only evacuations but also repair of lung injuries were performed. Patients with penetrating injury or blunt injury with massive bleeding, that required emergency thoracotomy, were excluded from the study, in addition to those with cardiovascular or oesophageal injuries.


RESULTS
During the study period, 88 patients who underwent thoracoscopy were enrolled. Among them, 43 patients undergoing the simple thoracoscopic evacuation method were stratified into Group 1. The remaining 45 patients who underwent thoracoscopic evacuation combined with resection of lung lacerations were stratified into Group 2. The rates of post-traumatic infection were higher in Group 1. The durations of chest-tube drainage and ventilator usage were shorter in Group 2, as were the lengths of patient intensive care unit stay and hospital stay.


CONCLUSIONS
When compared with simple thoracoscopic evacuation methods, repair and resection of the injured lungs combined may result in better clinical outcomes in patients who sustained blunt chest injuries.
Division of Trauma, Department of Emergency, Veterans General Hospital, Kaohsiung, Taiwan Shih-Chien University, Taipei, Taiwan.
Yi-Pin
YP
Chou
Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Liang-Chi
LC
Kuo
Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine, Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kwan-Ming
KM
Soo
Division of Trauma, Department of Emergency, Veterans General Hospital, Kaohsiung, Taiwan.
Yih-Wen
YW
Tarng
Shih-Chien University, Taipei, Taiwan.
Hsin-I
HI
Chiang
Division of Trauma, Department of Emergency, Veterans General Hospital, Kaohsiung, Taiwan hsinglin2002@yahoo.com.tw.
Fong-Dee
FD
Huang
Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine, Department of Emergency Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan hsinglin2002@yahoo.com.tw.
Hsing-Lin
HL
Lin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes / Q000706:statistics & numerical data; D004322:Drainage; D005260:Female; D006491:Hemothorax / Q000628:therapy*; D006801:Humans; D022125:Lacerations / Q000145:classification / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D055370:Lung Injury / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000628:therapy; D011014:Pneumonia / Q000453:epidemiology; D011030:Pneumothorax / Q000628:therapy; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013352:Subcutaneous Emphysema / Q000628:therapy; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000601:surgery; D055815:Young Adult
Blunt thoracic injury; Haemothorax; Pneumothorax; Thoracotomy; Video-assisted thoracoscopic surgery