Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVIII: Wounds and Injuries of the Chest
United States Department of Defense
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About 15% of combat injuries sustained during conventional land warfare will involve the thoracic viscera and/or the chest wall. In two-thirds, the thoracic wound will be the principle injury. The spectrum of injury ranges from casualties with grossly mutilating blast injuries to those with only tiny superficial fragment wounds. The great majority of chest casualties will have penetrating trauma. After excluding the approximately 10% with only soft tissue wounds, the remainder can be categorized into two populations: about two-thirds will have missile wounds of the heart, great vessels, or pulmonary hilum; and the others will have missile wounds of the pulmonary parenchyma. It is unusual for casualties in the former category to present as treatment problems, since the vast majority exsanguinate before reaching a medical treatment facility. By way of contrast, casualties with wounds of the lung usually survive to reach medical treatment, which in most instances involves no more than the insertion of a chest tube. About 5% of the total thoracic casualty population will have sustained blunt trauma, more often than not occurring when an armored fighting vehicle is damaged by a mine. Viewed from the historical perspective, the principal function of thoracic surgery in wartime has not been the performance of emergency life-saving surgery, but rather the management of chronic complications such as clotted hemothorax and empyema. Whether better field resuscitation, more rapid evacuation from the battlefield, and the availability of surgeons trained in the management of thoracic trauma will change the role of thoracic surgery is unclear.
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