Advances in the management of thoracic trauma

Abstract

Thoracic trauma is the second most common cause of mortality of all traumatic injuries, accounting for about 25% of traumatic deaths. The present review focuses on the advances of the relevant literature regarding the most appropriate approach and definitive treatment of thoracic trauma. The universal clinical application of focused assessment with sonography for trauma (FAST) has greatly enhanced the tool for traumatic diagnosis, monitoring, and interventional procedural guidance. FAST has been used as an efficient triaging tool in blunt thoracic trauma patients. Additionally, video-assisted thoracoscopic surgery (VATS) has been established as safe and effective for managing thoracic trauma in hemodynamically stable patients. VATS for specific indications in thoracic trauma is associated with improved outcomes, decreased morbidity and mortality, and shortened hospital stay. Emergency resuscitative thoracotomy (ERT) is an accepted intervention for penetrating cardiothoracic trauma patient in extremis. However, its role in blunt trauma patient in extremis has been challenged and has been a subject of considerable debate. The treatment of flail chest injuries has undergone dramatic evolution over the last hundred years. Surgical stabilization of severe rib fractures offers several theoretical advantages, but the use of surgery for the treatment of flail chest is still controversial. For the treatment of deep pulmonary lacerations, the techniques that achieve hemostasis while preserving the maximal amount of pulmonary parenchyma are desirable. Lung-sparing technique is an less extensive surgical techniques of repair and resection surgical including suture pneumonorrhaphy, stapled and clamp pulmonary tractotomy with selective vessel ligation, and non-anatomic resection. The management of traumatic aortic injury has been transformed through the application of thoracic endovascular aortic repair (TEVAR). TEVAR has been increasingly used for definitive treatment and its outcomes appear to be at least equally safe and effective as those of open repair. Finally, extracorporeal organ support is becoming more commonplace in trauma critical care management as clinical evidence for the merits of this approach builds.