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European Journal of Cardio-Thoracic Surgery, Vol 11, 399-405, Copyright © 1997 by European Association for Cardio-thoracic Surgery
B Biocina, Z Sutlic, I Husedzinovic, I Rudez, R Ugljen, D Letica, Z Slobodnjak, J Karadza, V Brida, T Vladovic-Relja and I Jelic
OBJECTIVE: Penetrating cardiothoracic war wounds are very common among war
casualties. Those injuries require prompt and specific treatment in an aim
to decrease mortality and late morbidity. There are a few controversies
about the best modality of treatment for such injuries, and there are not
many large series of such patients in recent literature. METHODS: We
analysed a group of 259 patients with penetrating cardiothoracic war wounds
admitted to our institutions between May 1991 and October 1992. RESULTS:
There were 235 (90.7%) patients with thoracic wounds, 14 (5.4%) patients
with cardiac, wounds and in 10 (3.7%) patients both heart and lungs were
injured. The cause of injury was shrapnel in 174 patients (67%), bullets in
25 patients (9.7%), cluster bomb particles in 45 patients (17.3%) and other
(blast etc.) in 15 patients (6%). Patients, 69, had concomitant injuries of
various organs. The initial treatment in 164 operated patients was chest
drainage in 76 (46.3%) patients, thoracotomy and suture of the lung in 71
(43.2%) patients, lobectomy in 12 (7.3%) patients and pneumonectomy in 5
(3%) patients. Complications include pleural empyema and/or lung abscess in
20 patients (8.4%), incomplete reexpansion of the lung in 10 patients
(4.2%), osteomyelitis of the rib in 5 patients (2.1%) and bronchopleural
fistula in 1 patient (0.4%). Secondary procedures were decortication in 12
patients, rib resection in 5 patients, lobectomy in 2 patients,
pneumonectomy in 4 patients, reconstruction of the chest wall in 2 patients
and closure of the bronchopleural fistula in 1 patient. The cardiac chamber
involved was right ventricle in 12 patients, left ventricular in 6
patients, right atrium in 7 patients, left atrium in 3 patients, ascending
aorta in 2 patients and 1 patient which involved descending aorta, right
ventricle and coronary artery (left anterior descending) and inferior vena
cava, respectively. The primary procedure was suture in 17 patients (in 10
patients with the additional suture of the lung), suture + extraction of
the foreign body in 4 patients, 2 of them with cardiopulmonary bypass.
Complications were pericardial effusion in 6 patients, arrhythmia in 2
patients, myocardial infraction in 1 patient and migration of the foreign
body in 1 patient. Patients, 7, died, five of the group with concomitant
injuries, two of thoracic and one of cardiac injuries (5, 1.2 and 4.2%,
respectively). CONCLUSIONS: Penetrating cardiothoracic wounds are among the
most serious injuries in war, either in combat or among civilians. In spite
of their nature, they can be treated successfully with relatively low
mortality and morbidity.
ARTICLES
Penetrating cardiothoracic war wounds
Department of Cardiac Surgery, Clinical Hospital Centre Dubrava, Zagreb, Croatia.
This article has been cited by other articles:
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  N. Hudorovic ICVTS on-line discussion A Venous war injuries Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 650 - 651. [Full Text] [PDF]
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 J. Garner The early hospital management of gunshot wounds. Part 1: head, neck and thorax Trauma, July 1, 2005; 7(3): 143 - 154. [Abstract] [PDF]
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