The Surgical Treatment of Lung Lacerations and Major Bronchial Disruptions Caused by Blunt Thoracic Trauma

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Abstract
The records of 16 patients who suffered blunt thoracic trauma, causing lung lacerations in 13, bronchial disruptions in 2, and lung laceration with bronchial disruption in 1, were reviewed to investigate the correlations between clinical factors and prognosis. The causes of these injuries included 14 traffic accidents and 2 construction-related accidents, and the indications for surgery were massive bleeding in 12 patients, massive air leakage in 2, both in 1, and lung abscess in 1. Of the 16 patients, 11 (68.8%) underwent thoracotomy less than 4 h after admission, 3 (18.8%) underwent thoracotomy 4 to 24 h after admission, and 2 (12.5%) underwent thoracotomy 24 h or later after admission. The operative techniques included 1 pneumonectomy, 5 lobectomies, 2 bronchoplasties, and 8 minor repairs. The mortality rate was 43.7%, which included six early deaths occurring within 72 h of the trauma, and one late death. While major bronchial disruption is usually associated with a good prognosis, univariate and multivariate analyses demonstrated that intrapleural bleeding of 300 ml/h or more from time of trauma to chest tube drainage was significantly correlated with a poor prognosis. Moreover, an injury severity score (ISS) of 36 or more showed a trend toward a correlation with poor prognosis in patients with lung lacerations. Prompt thoracotomy will decrease mortality rate of patients suffering lung lacerations resulting in intrapleural bleeding of more than 300 ml/h.

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