War injuries to the chest.

AIM: Presentation of our experiences in the treatment of war injuries to the chest at the Split University Hospital, Croatia, during the 1991-1995 war in Croatia and Bosnia-Hercegovina. METHODS: Retrospective analysis of clinical and surgical data on 439 (16.3%) patients with war injuries to the chest among 2693 treated battle casualties in general. The medical data from evacuation unit, transportation, emergency department and follow-up were observed and processed by basic statistical analysis. RESULTS: There were more explosive wounds than gunshot and puncture wounds (ratio 251/158/30). Penetrating injuries were found in 348 (79%) patients and nonpenetrating in 91 (21%) patients. There were 401 (91%) men and 38 (9%) women. Thoracotomy was performed in 98 (22.3%) patients, whereas conservative surgical methods (wound treatment, chest-tube drainage, appropriate fluid therapy, antimicrobial and atelectasis prophylaxis) were used in 341 (77.7%) patients. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 411 (93.6%) patients, 19 (4.3%) patients were referred to other institution for further treatment, and 9 (2%) severely wounded persons died. CONCLUSIONS: The treatment of respiratory insufficiency and haemorrhage shock, and prevention of infection are the basis of management of these injuries. Prompt transportation, appropriate diagnostic methods and an adequate surgical treatment can markedly reduce mortality and complications rate in war injuries to the chest. Most war wound of the lung can be successfully managed by "conservative" surgical treatment. The recovery of lung function was similar in conservatively and operatively treated patients.

[Our initial experience with video-assisted thoracoscopic surgery (VATS)]. / Nasa prva iskustva u videotorakoskopskoj kirurgiji (VATS).

Diagnostic and therapeutic potentials and our first two-year experience with video-assisted thoracic surgery (VATS) are reported. From May 1995 to April 1997, at the Department of Surgery, University Hospital Split, VATS approach was planned in 55 cases (recurrent pneumothorax in 23, tension pneumothorax in 1, traumatic effusion in 5, malignant metastatic lung tumor in 1, benignant lung tumor in 11, traumatic effusion in 5, suspected mediastinal lymph nodes in 4, long lasting unconfirmed pleural effusion in 9, foreign body in 1, mediastanal cyst in 1). Of these, 48 procedures (87.2%) were performed using VATS (diagnostic thoracoscopy in 12, wedge resection with or without pleural abrasion in 21, partial pleurectomy in 1, decortications in 3, mediastinal lymph nodes biopsy in 4, lung biopsy in 7). Seven patients (12.7%) underwent conventional posterolateral thoracotomy. Complications included persistent air leak in three patients, prolonged bleeding in one patient and supraventricular tachycardia in one patient. The mean duration of chest tube drainage after the procedure was 3.7 days (range 2 to 19 days), and mean hospital stay was 5.1 days (range 3 to 15 days). All patients received routine antimicrobial chemoprophylaxis with single-dose ceftriaxone 2 g intravenously immediately prior to the surgery, and average postoperative patient-controlled analgesia with buprenorphine 0.15 mg. We conclude that VATS is a very useful alternative to conventional thoracotomy in managing cases of exploration, recurrent spontaneous pneumothorax, benign pulmonary lesions, solitary pulmonary nodes, early decortications and different intrathoracic biopsies.

Recovery of respiratory functional defects after war injuries to the chest.

AIM: Assessment of lung function before, during, and after surgical treatment of war injuries to the chest, and comparison of conservative and operative surgical approach. PATIENTS AND METHODS: A retrospective study of 439 patients with war injuries to the chest inflicted during the wars in Croatia and Bosnia and Herzegovina was performed. Patients were classified by injury mechanism and by physiologic scoring on admission, according to the cardiovascular-respiratory elements of the Injury Severity Score (ISS). "Conservative" surgical treatment with chest tube drainage, appropriate fluid therapy, and antimicrobial and atelectasis prophylaxis was performed in 358 (81.5%) and operations in 81 (18. 5%) patients. Blood gases were analyzed before, during, and after surgical treatments. Pulmonary function was assessed after the stabilization of patients' clinical condition and 3-6 months after the injury. RESULTS: On admission, blood gas profiles showed slight to moderate hypoxemia with consecutive hypercapnia related to the severity of injuries. Surgical treatment left a minimum degree restrictive disorder of ventilation without an obstructive pattern. Definitive repair of lung function presented with normalization of blood gas data, and significantly improved restrictive pattern (p<0.05). There was no difference in definitive lung function between conservatively and operatively treated patients. Mortality was 2%. CONCLUSION: The success of surgical resuscitation was related to ISS scoring. Recovery of respiratory function defects after the injury was not significantly related to the mechanism of injury or the patient's condition at arrival. The recovery of lung function was similar in conservatively and operatively treated patients.