PENETRATING CARDIOTHORACIC WAR WOUNDS

Objective: Penetrating cardiothoracic war wounds are very common among war casualties. Those injuries require prompt and specific treatment in an aim to decrease mortality and late morbidity. There are a few co ntroversies about the best modality of treatment for such injuries, an d there are not many large series of such patients in recent literatur e. Methods: We analysed a group of 259 patients with penetrating cardi othoracic war wounds admitted to our institutions between May 1991 and October 1992. Results: There were 235 (90.7%) patients with thoracic wounds, 14 (5.4%) patients with cardiac wounds and in 10 (3.7%) patien ts both heart and lungs were injured. The cause of injury was shrapnel in 174 patients (67%), bullets in 25 patients (9.7%), cluster bomb pa rticles in 45 patients (17.3%) and other (blast etc.) in 15 patients ( 6%). Patients, 69, had concomitant injuries of various organs. The ini tial treatment in 164 operated patients was chest drainage in 76 (46.3 %) patients, thoracotomy and suture of the lung in 71 (43.2%) patients , lobectomy in 12 (7.3%) patients and pneumonectomy in 5 (3%) patients . Complications include pleural empyema and/or lung abscess in 20 pati ents (8.4%), incomplete reexpansion of the lung in 10 patients (4.2%), osteomyelitis of the rib in 5 patients (2.1%) and bronchopleural fist ula in 1 patient (0.4%). Secondary procedures were decortication in 12 patients, rib resection in 5 patients, lobectomy in 2 patients, pneum onectomy in 4 patients, reconstruction of the chest wall in 2 patients and closure of the bronchopleural fistula in 1 patient. The cardiac c hamber involved was right ventricle in 12 patients, left ventricular i n 6 patients, right atrium in 7 patients, left atrium in 3 patients, a scending aorta in 2 patients and in 1 patient which involved descendin g aorta, right ventricle and coronary artery (left anterior descending ) and inferior vena cava, respectively. The primary procedure was sutu re in 17 patients (in 10 patients with the additional suture of the lu ng), suture + extraction of the foreign body in 4 patients, 2 of them with cardiopulmonary bypass. Complications were pericardial effusion i n 6 patients, arrhythmia in 2 patients, myocardial infraction in 1 pat ient and migration of the foreign body in 1 patient. Patients, 7, died , five of the group with concomitant injuries, two of thoracic and one of cardiac injuries (5, 1.2 and 4.2%, respectively). Conclusions: Pen etrating cardiothoracic wounds are among the most serious injuries in war, either in combat or among civilians. In spite of their nature, th ey can be treated successfully with relatively low mortality and morbi dity. (C) 1997 Elsevier Science B.V.