Selective packing for uncontrollable traumatic thoracic wall bleeding preserving cardiopulmonary function

Am J Surg. 2017 Sep;214(3):413-415. doi: 10.1016/j.amjsurg.2016.11.041. Epub 2016 Dec 21.

Abstract

Background: Uncontrollable chest wall bleeding secondary to thoracic trauma has been a challenging problem faced by surgeons. Thoracic packing has been described as a good alternative although most thoracic surgeons avoid it because of the potential deleterious effects on cardiopulmonary function.

Methods: We describe a selective gauze packing technique of the thoracic wall preserving cardiopulmonary function in 3 patients with uncontrollable bleeding, where gauze packs were placed on bleeding areas holding them in a "sandwich-like" arrangement between the skin and the pleura and tightly fixed with coated wire stitches using internal and external-thoracic Ventrofil® devices.

Results: Successful hemostasis and cardio-respiratory stability were achieved in all cases after selective packing. X-ray showed acceptable lung expansion and no heart compression.

Conclusions: This selective packing technique is simple, feasible and highly effective in managing uncontrollable post-traumatic or even post-operative chest wall hemorrhages when the life of patients is in danger.

Keywords: Bleeding; Packing; Thoracic wall; Trauma; Uncontrollable.

MeSH terms

  • Bandages*
  • Heart / physiology
  • Hemorrhage / etiology*
  • Hemorrhage / therapy*
  • Hemostasis
  • Hemostatic Techniques*
  • Humans
  • Lung / physiology
  • Severity of Illness Index
  • Thoracic Injuries / complications*
  • Thoracic Injuries / surgery
  • Thoracic Wall / injuries*