Our Experience in the Treatment of Severe Thoracic Trauma.

Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate   less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart & great vessel injuries. Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service Material and methods: 95 patients are treated in our hospital during July  2004- July 2017 timeframe. Male to  female was  ratio 3:1. Age of presentation  9-71 years old, mean age presentation 49  years old. Blunt chest wall trauma 36 (38%) and  penetraiting  chest wall trauma 59 (62%) patients. Ribs  and sternal fractures , two  or  more costal fractures in 15 (15.7%) patients  (flail chest 7 patients );unilateral pneumothorax  34 (35.7%) patients ,bilaterally  pmeumothorax 10 (10.5%) patients;massive hemothorax 12 (12.6%) patients , pneumomediastin et subcutaneous emphysema 6 (6.31%) patients Hammans syndrome, lung contusion and parenchimal pulmonary hemathoma in 15 (15.7%) patients; bronchial rupture 2 (2.1%) patients ,tracheal rupture 1 (1%) patient. Results: Only  medical treatment in 22 (23%) patients,unilateral pleural tub drainage 42 (44%) patients, bilateral chest drainage 18  (18.9%) patients ;thoracotomy  in 29(30.5%) patients ,wedge resection,lung hemostasis and aerostasis from lung lacerations, bronchial  lobar  rupture left lower lob 1 (1%) patient, bilateral thoracotomy 3 (3%) patients, clamshell  incision in 1 (1%)  patient;,thoracoabdominal approach 2 ( 2%) patients. flail chest wall  stabilization 7 (7.3%) patients by vicryl suture  ,steel wire suture 3(3%)patients,titanium plate 3(3%) patient.By VATS are treated 2(2.1%) patients.Mean hospital stay was 11 days (average 3-36 days).Morbidity rate in 6 (6.3%)patients , mortality was on 5  (5%)patients. Conclusion: Most common injury locations was  lung and chest wall and  less common abdominal and cranial trauma.Surgical and intensive treatment are very important and with low mortality rate.