title: Operating on penetrating trauma to the mediastinal vessels.
abstract: OBJECTIVE
  Patients with penetrating trauma of the major vessels of the chest are infrequently encountered. This is due to the fact that the majority of these patients die on scene, as well as due to the overall dramatic decline in the incidence of penetrating trauma in the Western world. A certain proportion of survivors are physiologically stable and can be transferred to adequate care. Patients who are physiologically unstable must be dealt with by the surgeons available without delay. Rapid diagnosis and operation can salvage patients who would otherwise be lost, and all general surgeons should be capable of recognizing these injuries and intervening if a trauma and/or cardiothoracic surgeon is not immediately available.
  
  
  METHODS
  Technical description of practical emergency surgery approaches to patients bleeding to death from penetrating mediastinal vessel injuries.
  
  
  RESULTS
  The scope of this review familiarizes the "uninitiated" surgeon with the operative management of this rare and lethal type of injuries. Technical aspects are described, and pitfalls as well as tips and tricks of the trade are discussed.
  
  
  CONCLUSIONS
  Patients with penetrating injuries to the mediastinal vessels can be saved by swift and knowing operative management of this rare and lethal type of injuries, even if a trauma and/or cardiothoracic surgeon is not immediately available.
authors: Department of Surgery, Baskent University, Izmir, Turkey.
authors: T H
authors: TH
authors: Yilmaz
authors: Department of Anaesthesiology and Intensive Care, Military Hospital Ulm, Teaching Hospital of the University of Ulm, Ulm, Germany.
authors: T
authors: T
authors: Evers
authors: Department of Cardiothoracic Surgery, Milpark Hospital, Johannesburg, South Africa.
authors: M
authors: M
authors: Sussman
authors: Directorate for Trauma and Burns, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand Medical School, Johannesburg, South Africa.
authors: P
authors: P
authors: Vassiliu
authors: Directorate for Trauma and Burns, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand Medical School, Johannesburg, South Africa.
authors: E
authors: E
authors: Degiannis
authors: Directorate for Trauma and Burns, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand Medical School, Johannesburg, South Africa Department of Surgery, St Marien Hospital Vechta, Teaching Hospital MHH Hannover University, Vechta, Germany Vechta Institute for Research Promotion & Interdisciplinary Research (Vechtaer Institut für Forschungsförderung VIFF e.V.), Vechta, Germany ddoll@gmx.de.
authors: D
authors: D
authors: Doll
keywords: Major mediastinal vessels; emergency room surgery; gunshot; gunshot wound chest; mortality; resus room mortality