Thoracic damage control surgery

The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care.

Keywords:
Multiple Trauma; Thoracic Injuries; Emergency Medicine

Authorship

Roberto Gonçalves TCBC-SP

Faculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery - São Paulo - SP - BrazilFaculty of Medical Sciences of the São Paulo Holy HomeBrazilSão Paulo, SP, BrazilFaculty of Medical Sciences of the São Paulo Holy Home, Department of Surgery - São Paulo - SP - Brazil

Roberto Saad JrTCBC-SP

Mailing address: Roberto Gonçalves E-mail: rgtorax@yahoo.com.br

Conflict of interest: none.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (6)

Thumbnail

Figure 1
Aspects of cardiac and vascular damagecontrol. A) Cardiac wound synthesis with metal clips through an left anterolateral thoracotomy; B) Positioning ofendoarterial shunt with a 22F chest tube segment in a descending aortic injury.

Thumbnail

Figure 2
Aspects of lung damage control: A) Clamping of the pulmonary hilum after release of the pulmonary ligament; B) Tractotomy with stapler in tunnelling, bleeding lesion in the left upper lobe; C) Selective ligation after lung tractotomy; D) Left pneumonectomy with stapler. E) Justa-pericardial staples line; F) Specimen from pneumonectomy, with the line of staples on the left hilum (details in the text).

Thumbnail

Figure 3
Chest radiography in the postoperative period of thoracic packaging for coagulopathy. Note the presence of radiopaque stripes of seven packs in the left hemithorax.

Thumbnail

Figure 4
A) Positioning of a large caliber Kher drain in an esophageal injury. The schematic detail depicts the approaching of the lesion, the passing of nasal-enteral feeding tubes inside the "T" drain and the fixation with absorbable sutures in the diaphragm; B) Exteriorization of the Kherdrain through the chest wall

Thumbnail

Figure 5
A) Thoracic Packing after sternotomy and coagulopathy. After placing packs in the mediastinum and sternum, a suction drain was placed and adhesive fields applied to seal the dressing (VAC technique); B) Mediastinal appearance with firm clots after the patient homeostasis restoration.

Thumbnail

Figure 6
A) Infected pleural and mediastinal wound; B) Vacuum dressing aspect with sponges, suction drain and adhesive drape; C) Evolution of the wound with sanitation of the pleural space and development of granulation tissue; D) Final phase of wound evolution, with obliteration of the pleural space and exuberant granulationtissue; after this phase a skin flap was performed, with satisfactory functional and aesthetic result.

Figure 1 Aspects of cardiac and vascular damagecontrol. A) Cardiac wound synthesis with metal clips through an left anterolateral thoracotomy; B) Positioning ofendoarterial shunt with a 22F chest tube segment in a descending aortic injury.

Figure 2 Aspects of lung damage control: A) Clamping of the pulmonary hilum after release of the pulmonary ligament; B) Tractotomy with stapler in tunnelling, bleeding lesion in the left upper lobe; C) Selective ligation after lung tractotomy; D) Left pneumonectomy with stapler. E) Justa-pericardial staples line; F) Specimen from pneumonectomy, with the line of staples on the left hilum (details in the text).

Figure 3 Chest radiography in the postoperative period of thoracic packaging for coagulopathy. Note the presence of radiopaque stripes of seven packs in the left hemithorax.

Figure 4 A) Positioning of a large caliber Kher drain in an esophageal injury. The schematic detail depicts the approaching of the lesion, the passing of nasal-enteral feeding tubes inside the "T" drain and the fixation with absorbable sutures in the diaphragm; B) Exteriorization of the Kherdrain through the chest wall

Figure 5 A) Thoracic Packing after sternotomy and coagulopathy. After placing packs in the mediastinum and sternum, a suction drain was placed and adhesive fields applied to seal the dressing (VAC technique); B) Mediastinal appearance with firm clots after the patient homeostasis restoration.

Figure 6 A) Infected pleural and mediastinal wound; B) Vacuum dressing aspect with sponges, suction drain and adhesive drape; C) Evolution of the wound with sanitation of the pleural space and development of granulation tissue; D) Final phase of wound evolution, with obliteration of the pleural space and exuberant granulationtissue; after this phase a skin flap was performed, with satisfactory functional and aesthetic result.

How to cite

copy

Colégio Brasileiro de Cirurgiões Rua Visconde de Silva, 52 - 3º andar, 22271- 090 Rio de Janeiro - RJ, Tel.: +55 21 2138-0659, Fax: (55 21) 2286-2595 - Rio de Janeiro - RJ - Brazil
E-mail: revista@cbc.org.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês
Português

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Thoracic damage control surgery

PlumX

Mensagem

[1] Mailing address: Roberto Gonçalves E-mail: rgtorax@yahoo.com.br