Indications for surgery in penetrating chest injuries.

This study is concerned with the outcome of treatment of 933 patients with penetrating gunshot chest injuries at the Medical Academy in Afghanistan. The most important factors to determine the choice of management were the general state of the patient, the type and location of the injury and the arrival time. 326 (34.9%) patients needed thoracic resuscitation. There were 117 (12.6%) cases of thoracotomy (91 emergency, 26 early operations). Of the conservative treatment group there were 636 (68.2%) cases of thoracostomy, 105 (11.2%) of repeated thoracocentesis, and as few as 75 (8.0%) required medical treatment only. There were 106 cases of the late thoracotomy because of empyema in 97 patients, fibrothorax and foreign body in eight cases and lung cystoma in one patient. The overall mortality rate was 9.4% with 5.5% in the group of isolated injuries and 26.7% in the group of combined injuries. The long-term results show that 488 (86.5%) of 564 patients were well enough to return to work and 39 (6.9%) were still suffering from secondary pulmonary disease.