Emergency Thoracic Surgery in Chest Trauma at the Komfo Anokye Teaching Hospital in Ghana: The Role of Sternotomy and Thoracotomy

Abstract

Objective: Chest trauma, as blunt or penetrating injury, account for significant amount of all traumatic injuries. They are associated with high mortality of about 75% of all trauma-related deaths, either from direct or indirect consequence of the injury. Nearly 80-85 % of chest trauma is managed conservatively with only about 10-15 % needing emergency surgery.
Methodology: A retrospective cohort study of patients presenting with chest trauma and undergoing emergency thoracic surgery at the Komfo Anokye Teaching Hospital from January 2015 to June 2020 was carried out.
Results: There were 29 patients, with 82.8% (24) being males. The mean age was 33.8 ± 15.0 years with range of 5-65 years. The leading mechanism of chest trauma was penetrating chest injury, which accounted for 51.7% (15). Eighteen (86%) patients underwent exploratory thoracotomy with 5 (10%) having exploratory sternotomy and the remaining 4% undergoing other procedures. Fourteen (82.1%) patients out of the eighteen who underwent the thoracotomy had a left thoracotomy with four (24.1%) patients having right thoracotomy. The major indication for surgery in acute thoracic trauma was traumatic diaphragmatic rupture (62.1%) followed by
impalement injury (17.2%), traumatic thoracotomy (6.9%), cardiac tamponade (6.9%), massive haemothorax (3.5%), and vascular injury (3.5%). There were no mortality over the 5-year period.
Conclusion: The leading indication for emergency thoracic surgery in chest trauma was traumatic diaphragmatic rupture caused mostly by penetrating thoracic injury. Thoracotomy was the major emergency thoracic surgical approach performed.