Subscribe to RSS
DOI: 10.1055/s-2001-16099
Bronchial Repair with Pulmonary Preservation for Severe Blunt Trauma[∗]
Publication History
Publication Date:
31 December 2001 (online)
After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib fractures, left-sided tension pneumothorax, hemothorax and left upper lobe bronchus rupture at its origin. An emergency left thoracotomy revealed an almost complete avulsion of the upper lobe bronchus from the main stem bronchus, a severely damaged pulmonary artery, and a concurrent deep intraparenchymal lower lobe laceration. Since the patient was hemodynamically stable, a decision was made to preserve as much lung as possible. In the event of complex pulmonary trauma, pulmonary preservation is desirable since emergency pneumonectomy is usually associated with high mortality. Early bronchoscopic assessment, careful anesthetic management, and meticulous surgical technique with liberal use of fibrin glue were crucial to successful outcome.
Key words:
Blunt thoracic trauma - Bronchial avulsion - Fibrin glue
1 Dr. Rocco is presently Consultant Thoracic Surgeon, Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
References
- 1 Bowling R, Mavroudis C, Richardson J D. et al . Emergency pneumonectomy for penetrating and blunt trauma. Am Surg . 1985; 51 136-139
- 2 LoCicero J, Mattox K L. Epidemiology of chest trauma. Surg Clin North Am. 1989; 69 15-19
- 3 Tominaga G T, Waxman K, Scannell G. et al . Emergency thoracotomy with lung resection following trauma. Am Surg . 1993; 59 834-837
- 4 Shigeta O, Makuuchi H, Kaneko Y. et al . A case of bronchial rupture and pulmonary laceration caused by blunt chest trauma. Kyobu Geka. 1994; 47 581-584
- 5 Nakamura H, Taniguchi Y, Ito N. et al . A case of successful endoscopic treatment for traumatic bronchial rupture. Kyobu Geka. 1997; 50 589-593
- 6 McCarthy P M, Trastek V F, Bell D G. et al . The effectiveness of fibrin glue sealant for reducing experimental pulmonary air leak. Ann Thorac Surg. 1988; 45 203-205
- 7 Wong K, Goldstraw P. Effect of fibrin glue in the reduction of postthoracotomy alveolar air leak. Ann Thorac Surg. 1997; 64 979-981
- 8 Bayfield Ms, Spotnitz W D. Fibrin sealant in thoracic surgery. Pulmonary applications, including management of bronchopleural fistula. Chest Surg Clin N Am. 1996; 6 567-583
1 Dr. Rocco is presently Consultant Thoracic Surgeon, Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
Received for Publication: November 9, 1999
Gaetano RoccoM.D.
Department of Cardiothoracic Surgery
Northern General Hospital
Herries Road S5 7AU Sheffield,
United Kingdom
Phone: +44-114-2714950
Fax: +44-114-2610350
Email: grocco@tany.fsnet.co.uk