Abstract
BackgroundTractotomy has become the standard of care for transfixing through-and-through lung injuries as it can be performed quickly with little blood loss and a low risk of complications. However, packing with laparotomy pads could be a feasible alternative to tractotomy on selected patients. We describe a series of four patients with lung trauma in which packing of the pulmonary wound tract was used as the primary and unique surgical strategy for arresting hemorrhage from injuries of the lung parenchyma.MethodsPacking of the traumatic tract is achieved by gently pulling a laparotomy pad with a Rochester clamp and adjusting it to the cavity to stop the bleeding. The pack is removed in a subsequent surgery by moistening and tractioning it softly to avoid additional damage. The operation is completed by manual compression of the wounded lobe. We present a case series of our experience with this approach.ResultsFrom 2012 to 2016, we treated four patients with the described method. The mechanism was penetrating in all them. The clinical condition was of exsanguinations with multiple sources of hemorrhage. There were three patients with peripheral injuries to the lung and one with a central injury to the pulmonary parenchyma. Bleeding was stopped in all the cases. Three patients survived. A patient had recurrent pneumothorax which was resolved with a second chest tube.ConclusionPacking of the traumatic tract allowed rapid and safe treatment of transfixing through-and-through pulmonary wounds in exsanguinating patients under damage control from several bleeding sources.
Highlights
Tractotomy has become the standard of care for transfixing through-and-through lung injuries as it can be performed quickly with little blood loss and a low risk of complications
We describe a series of four patients with lung trauma in which packing of the pulmonary wound tract was used as the primary and unique surgical strategy for arresting hemorrhage from injuries of the lung parenchyma
Packing of the pulmonary wound tract was used in four patients (Table 1)
Summary
Tractotomy has become the standard of care for transfixing through-and-through lung injuries as it can be performed quickly with little blood loss and a low risk of complications. The tenets of damage control surgery were popularized by Rotondo et al [1] in 1993 They established the feasibility of the damage control approach as an intervention to improve outcomes in severely injured patients. Damage control surgery has become increasingly accepted as the standard of care, as it provides a survival benefit among injured patients with physiologic derangements. The wide acceptance of damage control surgery for abdominal trauma allowed the translation and application of Packing has been used to successfully control bleeding from the thoracic wall, from oozing surfaces or the surgical wound [9–11]. Despite the potential benefit of being a life-saving procedure, there remains a paucity of evidence on the feasibility of the use of thoracic packing as a damage control technique in Garcia et al World Journal of Emergency Surgery (2019) 14:52 the management of lung trauma. We describe a series of four patients with lung trauma in which packing of the pulmonary wound tract was used as the primary and unique surgical strategy for arresting hemorrhage from injuries of the lung parenchyma
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call