Thoracic Impalement Injury

SavageGlow · #1 ● 08-01-2024, 04:03 PM

: A survivor with large metallic object in-situ

"A 25-year-old male send to emergency department (ED) due to thoracic impalement injury caused by a metallic bar. He crashed into a lorry from behind in high speed when he was driving a motor car. As a result, his car wind screen was broken, a blunt iron bar from the lorry pierced through his upper sternum and came out from posterior aspect of right thorax, below and lateral to tip of right scapula. The patient was stuck at the accident scene for almost an hour with severe pain and mild continuous bleeding. He was separated from damaged vehicle by rescue workers after cutting the metallic bar off the lorry and was brought to hospital with in-situ foreign body.

When an urgent thoracotomy was planned, regional blood bank was informed that a massive blood transfusion was needed. Without any radiological investigation, the patient was transferred to operating room immediately.

Limited right anterolateral thoracotomy was carried out by a team consisted of 2 general surgeons and a cardiothoracic surgeon, also a senior anesthetist who responsible for anesthesia.

We found this rusted metallic rod pierced the chest wall, fractured the adjacent ribs and pierced the right lung parenchyma lead to continuous bleeding. No major bronchial vessel or bronchus was damaged. The bar was removed under vision after separated from lung parenchyma with the help of linear cutting staplers. Hemostasis was secured and lung parenchyma damage was repaired.

Chest wall closed with non-absorbable prolene-1 sutures and muscles repaired with absorbable Vicryl-1 sutures. Skin closed with skin staplers. With a chest drain left in place, the patient was transferred to ICU, where he had kept for 3 days.

Post-operative chest X-ray showed fully expanded lung with no collection. Chest tube was removed at 4th day after operation. Patient was discharged at 5th day after operation. His follow-up visits were unremarkable and no significant sequelae of the injury were seen."