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Lung-Sparing Surgery After Penetrating Trauma Using Tractotomy, Partial Lobectomy, and Pneumonorrhaphy
George C. Velmahos, MD, PhD;
Craig Baker, MD;
Demetrios Demetriades, MD, PhD;
Jeremy Goodman;
James A. Murray, MD;
Juan A. Asensio, MD
Arch Surg. 1999;134:186-189.
Objective To evaluate the role of lung-sparing surgical techniques in the surgical management of penetrating pulmonary injuries.
Design Retrospective case series.
Setting Academic level I trauma center.
Patients and Methods Forty patients underwent thoracic surgery for penetrating lung injuries during a 63-month period from January 1993 to March 1997. Five (12.5%) underwent anatomical lobectomy, 3 (7.5%) pneumonorrhaphy, 9 (22.5%) stapled wedge resection, and 23 (57.5%) stapled tractotomy. In total, 34 patients (85%) were treated with stapling techniques (1 anatomical lobectomy, 1 pneumonorrhaphy, 9 stapled wedge resections, and 23 stapled tractotomies) and 35 (87.5%) underwent had lung-sparing surgery for trauma.
Results Morbidity and mortality rates were 40% and 5%, respectively. Patients who underwent anatomical lobectomy required longer mechanical ventilatory support, intensive care unit stay, and hospital stay and had a higher morbidity rate compared with patients who underwent lung-sparing surgery for trauma but had central and extensive pulmonary injuries. Stapled tractotomy was efficient in controlling bleeding and bronchial leaks, but, in 3 patients, parts of the divided lung parenchyma were devascularized and had to be resected.
Conclusions Lung-sparing surgery for trauma with the use of staplers can be used in the majority of patients with penetrating pulmonary injuries requiring operation. Stapled tractotomy is a rapid and effective method for controlling hemorrhage and air leaks.
From the Department of Surgery, University of Southern California and the Los Angeles County and University of Southern California Medical Center, Los Angeles.
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