Ulus Travma Acil Cerrahi Derg. 2015; 21(2): 152-156 | DOI: 10.5505/tjtes.2015.38354

Severe thoracic impalement injury: Survival in a case with delayed surgical definitive care

Sorinel Lunca, Corneliu Morosanu, Ovidiu Alexa, Mihaela Pertea
Department of Surgery, University of Medicine and Pharmacology “Gr. T. Popa” Iasi, Emergency Hospital “Sf. Ioan”, Iasi, Romania

Impalement injuries are rare and among the most spectacular and dramatic traumatic lesions. The survival of a patient with a thoracic
impalement injury is an extremely rare event. The objective of this study was to present the case of a 24-year-old male patient with a
severe thoracic impalement injury successfully treated despite his late arrival in our hospital. A log in 12 cm diameter penetrated his right thorax producing injuries of the right main bronchus, right pulmonary lobe, right subclavian artery as well as extensive parietal lesions. Definitive surgical repair of these lesions was performed more than seven hours after trauma. The management principles contributing to the successful outcome that we would like to emphasize are: rapid transportation and reaction of the trauma team, minimal manipulation of the impaling object, removal of the log as one piece under direct vision in the operating room, ventilatory support, extensive debridement, and lavage associated with appropriate antibiotherapy.

Keywords: Foreign body, impalement injury; thoracic injury; thoracotomy.

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Aðýr toraks penetran yaralanmasý: Kesin cerrahi tedavisi gecikmiþ olguda saðkalým

Sorinel Lunca, Corneliu Morosanu, Ovidiu Alexa, Mihaela Pertea
Grigore T. Popa Üniversitesi Týp Ve Eczacýlýk Fakültesi, Sf. Ioan Acil Hastanesi, Romanya Romanya

Kazýk þeklindeki cisimlerin batmalarýna baðlý penetran yaralanmalar seyrek görülen, en dikkat çekici ve dramatik travmatik lezyonlardan biridir. Toraksýn penetran yaralanmasý sonucu hastanýn saðkalmasý son derece nadir görülen bir olaydýr. Yirmi dört yaþýnda, göðüs kafesine kazýk batmasý sonucu aðýr derecede yaralanmýþ, hastanemize geç dönemde baþvurmasýna raðmen baþarýyla tedavi edilmiþ bir olguyu sunmaktayýz. On iki santimetre çapýnda bir kütük göðüs kafesinin sað tarafýna saplanmýþ, sað ana bronþ, sað akciðer lobu, sað subklavyen arteri yaralamýþ, yaygýn pariyetal lezyonlara neden olmuþtu. Bu lezyonlarýn kesin cerrahi onarýmý travmadan yedi saat sonra yapýlmýþtý. Vurgulamak isteyeceðimiz, baþarýlý sonuçlara katkýda bulunan tedavi ilkeleri: travma ekibinin hýzla olay yerine ulaþýmý ve olaya müdahalesi, batan cismin minimal manipülasyonu, ameliyathanede doðrudan görüþ altýnda batan cismin tek parça halinde çýkartýlmasý, solunum desteði, yaygýn debridman ve lavajla birlikte uygun antibiyoterapi.

Anahtar Kelimeler: Penetran yaralanmalar, torakotomi; toraks yaralanmasý; yabancý cisim.

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