Thoracic trauma – principals of surgical management

Thoracic trauma continues to be a significant surgical problem. It is estimated that 25% of trauma-related deaths are due to penetrating and blunt thoracic injuries. Principals of surgical management of specific thoracic injuries like: tension pneumothorax, open pneumothorax, massive haemothorax, flail chest, cardiac injuries, ruptures of the aorta, tracheobronchial tree lesions, oesophageal and diaphragmatic injuries have been reviewed. Awareness of the potential for deterioration and early correct identification of life threatening thoracic injuries are the keys to successful management. Good outcomes in the management of thoracic injuries depend on rapid transport of the injured patient to the hospital, effective diagnostic and therapeutic measures and an aggressive involvement of an experienced surgical team, optimally in the operating theatre. Successful management of these injuries depends on effective prioritisation of procedures based on the ABC principals combined with a rapid diagnosis of severe injuries and aggressive surgical treatment of life-threatening lesions following penetrating and blunt trauma. Rapid decompression of tension pneumothorax and emergency thoracotomy, especially in patients following penetrating thoracic trauma may result in good outcomes. Effective management of severe thoracic injuries requires an integrated approach and cooperation of a multidisciplinary trauma team, including experienced thoracic and cardiac surgeons.