Severe thoracic impalement injury: survival in a case with delayed surgical definitive care

Abstract

Impalement injuries are rare and among the most spectacular and dramatic traumatic lesions. The survival of a patient with a thoracic impalement injury is an extremely rare event. The objective of this study was to present the case of a 24-year-old male patient with a severe thoracic impalement injury successfully treated despite his late arrival in our hospital. A log in 12 cm diameter penetrated his right thorax producing injuries of the right main bronchus, right pulmonary lobe, right subclavian artery as well as extensive parietal lesions. Definitive surgical repair of these lesions was performed more than seven hours after trauma. The management principles contributing to the successful outcome that we would like to emphasize are: rapid transportation and reaction of the trauma team, minimal manipulation of the impaling object, removal of the log as one piece under direct vision in the operating room, ventilatory support, extensive debridement, and lavage associated with appropriate antibiotherapy.