Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.
Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.
Colomb Med (Cali). 2021 May 10;52(2):e4044683. doi: 10.25100/cm.v52i2.4683.
Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
损伤控制技术在过去 15 年中已应用于胸部创伤的管理。尽管发表的文献数量有限，但信息足以消除一些担忧并建立管理原则。解剖损伤的严重程度仅使少数特定病例适合进行损伤控制。在大多数情况下，生理紊乱的严重程度以及胸腔内或其他体腔隔室中的其他出血源的存在构成了缩短手术程序的指征。肺损伤的分类为外周性、贯通性和中央性或多发性，为暂时止血和损伤的确定性管理提供了指导原则：分别采用气胸引流、楔形切除术、切开术或解剖性切除术。确定特定模式，如需要进行抢救性开胸术或主动脉阻断术、存在大量血胸、中央性肺损伤、气管支气管损伤、大血管损伤、多处出血部位以及识别低体温、酸中毒或凝血病，这些都是行损伤控制开胸术的指征。在这些情况下，外科医生执行一个简短的程序，用填塞物填塞出血表面，用填塞物进行一些选定的外周性或贯通性肺损伤的初步处理，并推迟肺切除术，以尽可能选择性地夹闭肺门。通过缝合包扎伤口的皮肤或安装真空系统来实现缩短开胸术的关闭。在重症监护病房对患者的管理将有助于识别那些需要紧急再次干预的患者，并纠正其余患者的生理紊乱，以便为他们计划的再次干预和确定性管理做好准备。
