Multiple complex penetrating cardiac injuries: role of civilian trauma in the education of the combat general surgeon.
OBJECTIVE
To use a case report of a complex cardiac injury case to illustrate how civilian trauma can be used to train combat general surgeons.


METHODS
We report the case of a 23-year-old man who suffered three penetrating injuries to the left ventricle (LV) after multiple stab wounds to left chest. On hospital arrival he was conversant, hemodynamically stable, oxygenating well, and without signs of cardiac tamponade. He deteriorated and required an urgent exploratory thoracotomy. Intraoperatively, 2-, 3.5-, and 5-cm stellate lacerations were discovered in the LV near the aortic root, of which, two were full thickness. A simple pledgeted horizontal mattress suture was not sufficient to repair the injuries. The repair ultimately required a running polypropylene suture to control the hemorrhage. The patient was awake on postoperative day 0 and discharged on postoperative day 12 without significant complication.


CONCLUSIONS
This case illustrates several points for the combat surgeon. First, young men are able to tolerate catastrophic injuries, presenting with normal hemodynamics. Second, there are a variety of techniques to use when treating uncommon injuries. Finally, the surgeon needs the ability to improvise quickly and to apply surgical techniques to treat complex traumatic injuries successfully.
Department of Surgery, David Grant Medical Center, 101 Boden Circle, Travis Air Force Base, CA 94535.
Paul D
PD
Vu
Department of Surgery, University of California, Davis Medical Center, 2315 Stockton Boulevard, Room OP512, Sacramento, CA 95817.
Jason B
JB
Young
Department of Surgery, University of California, Davis Medical Center, 2315 Stockton Boulevard, Room OP512, Sacramento, CA 95817.
Edgardo S
ES
Salcedo
Department of Surgery, University of California, Davis Medical Center, 2315 Stockton Boulevard, Room OP512, Sacramento, CA 95817.
Joseph M
JM
Galante
D013502:General Surgery / Q000193:education*; D006335:Heart Injuries / Q000601:surgery*; D006352:Heart Ventricles / Q000293:injuries; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000193:education*; D009104:Multiple Trauma / Q000601:surgery*; D013536:Suture Techniques; D013908:Thoracotomy; D014481:United States; D014951:Wounds, Stab / Q000601:surgery*; D055815:Young Adult