The use of minimally invasive surgical procedures in complications of combat thoracic trauma

Abstract

Background. The incidence of chest injuries in the overall structure of combat surgical trauma is approximately 4 % in present-day military conflicts, and according to the data from Anti-Terrorist Operation/Joint Forces Operation in the Eastern Ukraine, it varies from 7.5 to 11.7 %. In case of penetrating chest injuries, the overall mortality reaches 10 %. Objective: to improve the treatment outcomes in chest injuries through the application of endovideosurgical technologies and local fibrinolytic therapy during the quaternary care in complications of combat thoracic trauma. Materials and methods. A clinical statistical analysis of the surgical outcomes was conducted in 103 victims with combat chest trauma, who received specialized thoracic surgical treatment for complications such as clotted hemothorax at the quaternary care level. The control group included 54 (52.4 %) casualties, and the experimental group included 49 (47.6 %). Results. According to the research findings, among the total number of chest injuries and traumas, lung injuries were the most common, accounting for 61.2 %. In the experimental group, lung injuries were identified in 27 cases. When analyzing the treatment of thoracic injuries and traumas in the control group, it was found that 21 (38.9 %) patients did not have sufficient pleural cavity drainage during the provision of primary medical and qualified care to eliminate hemo- and pneumothorax, and 33 (61.1 %) required various surgical procedures through thoracotomy accesses. Videothoracoscopy was performed in casualties with gunshot penetrating chest injuries, when metal fragments were located in the anterior mediastinum (between the sternum and ascending aorta) and posterior mediastinum (between the right main bronchus and esophagus, without damage to them). The removal of metal fragments from the mediastinum, sanitation, and drainage of the pleural cavity were performed. Among 26 casualties, who underwent pleural drainage, 4 patients have had unstable vacuum in the pleural cavity for three days. Conclusions. The implementation of the developed differentiated surgical approaches in the patients with chest injuries and clotted hemothorax contributed to a reduction in specific injury complications from 24.1 to 8.2 % and allowed for a decrease in the duration of hospital stay from 24 to 16 bed-days.

Keywords

• combat chest injuries
• videothoracoscopy
• clotted hemothorax
• local fibrinolytic therapy