Abbreviated thoracotomy and temporary chest closure: an application of damage control after thoracic trauma.

HYPOTHESIS

Abbreviated thoracotomy, a damage-control strategy, improves survival in patients with metabolic exhaustion.

DESIGN

Case series report.

SETTING

University-based, level I trauma center.

PATIENTS

All patients admitted to our trauma center with severe chest trauma in whom an abbreviated thoracotomy was performed between January 1, 1994, and January 1, 1998.

INTERVENTIONS

Patients in whom an abbreviated thoracotomy was performed had their life-threatening thoracic injuries treated and had temporary closure of the incision. They were then resuscitated in the intensive care unit (ICU). Definitive care of injuries and formal chest closure were performed when physiological characteristics were normalized.

MAIN OUTCOME MEASURES

Survival to discharge and postoperative complications.

RESULTS

Of 10 787 patients admitted to the trauma center, 196 required thoracic operations. Eleven of these 196 patients underwent abbreviated thoracotomy; all patients survived to reach the ICU. Four died in the ICU within 24 hours of injury; the remaining 7 patients survived and were discharged. Based on their Trauma and Injury Severity Score, predicted mortality for our 11 patients was 59%; our mortality was 36%. Complications after abbreviated thoracotomy were similar to those seen after standard thoracotomy.

CONCLUSIONS

Abbreviated thoracotomy is a useful strategy in the treatment of severe chest trauma. Its use in situations of metabolic exhaustion or planned reexploration may increase patient survival rates by expediting transfer of the patient from the operating room to the ICU, where homeostasis can be restored.