Pulmonary tractotomy as an abbreviated thoracotomy technique

Background: Operative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-t hrough lung injuries that did not involve hilar vessels or airways. Pulmona ry tractotomy has evolved into use as an abbreviated thoracotomy technique in patients,vith severe thoracic or multivisceral trauma. As with any opera tive technique in high-risk patients, specific procedure-related complicati ons may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy. Methods: Medical records were retrospectively reviewed for 30 of 32 consecu tive tractotomy patients treated at Ben Taub General Hospital, during a 3-y ear period. By using a model for logistic regression analysis, the characte ristics of each patient and their clinical course were tested for impact on mortality. Results: Seventy percent of patients had at least one intraoperative parame ter indicative of acidosis (pH < 7.2), coagulopathy (prothrombin time > 13. 8 or partial thromboplastin time > 38.0 seconds), or hypothermia (core temp erature < 34 degrees C), and 50% of patients manifested two of these three parameters. The mortality rate among the 30 patients was 17%. Three of the five patients who died were noted to be acidotic, coagulopathic, and hypoth ermic. Twelve of 25 patients who survived more than 1 day had at least one thoracic complication. There were no late deaths. There was one failed trac totomy and one missed injury. A second thoracotomy was not required for con trol of a lung injury in any patient. Logistic regression analysis showed t hat intraoperative blood loss was the only predictive factor for mortality. Conclusion: Pulmonary tractotomy is a simple and effective technique in inj ured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as defini tive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.