Chest wall and diaphragm injury

Abstract

Despite improvements in body armor, chest wall injuries are still common enough in combat settings that the surgeon must have more than passing familiarity with the management of them. The injuries can range from simple rib fractures to massive tissue and rib loss with eviscerated and injured lung, scapula or shoulder girdle involvement, hemorrhage, and open pneumothorax. The vast majority of chest wall injuries can be temporized with damage control measures until other pressing injuries and physiologic needs can be addressed and stabilized. The reconstruction of chest wall defects from tissue loss can and should be delayed until the patient is evacuated to higher levels of care, or at least until hemorrhage is well controlled, the patient resuscitated, and contamination/infection cleared up.