[VATS in Thorax Trauma]

[Complications after conservative vs. operative treatment of severe thoracic trauma]

BACKGROUND

Thoracic trauma is a frequent injury in the routine treatment of injured patients. Due to the increasing demographic changes a further increase is to be expected, especially after low-energy trauma.

OBJECTIVE

Expected complications after conservative vs. operative treatment of various injury patterns of thoracic trauma.

MATERIAL AND METHODS

Evaluation of a selective literature search regarding possible complications after thoracic trauma and formulation of instructions for action as expert recommendations.

CONCLUSION

Both conservative and operative treatment of thoracic trauma have their specific complications, which have to be known to the treating physician. Lung contusions are often underestimated in the initial radiological diagnostics but often lead to relevant problems during the further course of treatment. After conservative treatment of rib fractures persistent pain, functional limitations or even relevant deformities due to secondary dislocation, can remain. There is a significant risk of overlooking or underestimating relevant injuries during the initial diagnostics which then leads to secondary complications. By far the most frequent risk of surgical treatment is an incorrect positioning of chest tubes. Overall, postoperative infections after chest trauma are relatively rare.

From diagnosis to therapy: the acute traumatic hemothorax - an orientation for young surgeons

Introduction

This review aims to provide an overview of diagnosing and managing traumatic haemothorax for young surgeons.

Content

Of 27,333 polytrauma patients in Germany in 2021, 35 % were admitted with thoracic trauma. In polytrauma patients, chest injuries are an independent negative predictor of 30-day mortality. These patients should be treated in an evidence-based and standardized manner to reduce mortality and morbidity. There are several methods of immediate diagnosis that should be used depending on hemodynamic stability. In addition to physical examination and chest X-ray, more specific techniques such as the eFAST protocol and Computed tomography (CT) of the chest  are available. Once the source of bleeding has been identified, acute treatment is given depending on hemodynamic stability. Thoracic drainage remains the gold standard in the initial management of hemothorax. If surgery is required because of an active source of bleeding, a hemothorax that has not been completely relieved, or associated injuries, either a minimally invasive or open approach can be used. The main focus is to stabilize the patient and avoid early and late complications.

Summary and Outlook

Rapid and prompt diagnosis and management of traumatic hemothorax is essential for patient outcome and should be taught to all young surgeons who are in direct contact with these patients.

[Treatment of Persistent Parenchymal Lung Injuries in Thoracic Trauma: Lung Laceration, Pleural Fistula and Pneumothorax]

Thoracic trauma is a frequent injury pattern with high patient morbidity and mortality. Preclinical and clinical emergency treatment is consented in a national S3-guideline. Following emergency therapy one third of patients may develop lung lacerations, pleural fistulation and persisting pneumothorax. An interdisciplinary working group of the German Society for Thoracic Surgery and the German Society for Traumatology reviewed the published medical literature on treatment of those injuries and assessed the existing evidence according to consensus recommendations. An inconsistent classification of those subsequent lung injuries was found. Evidence for diagnostic and therapeutic recommendations is small.