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Vol. 26. Issue 4.
Pages 140-143 (May 1990)
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Vol. 26. Issue 4.
Pages 140-143 (May 1990)
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Traumatismos penetrantes de torax: experiencia en 55 casos
Penetrating thoracic trauma: experience in 55 cases
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L. López, J. Freixinet, W. Torre, J.M. Mentrida, L. Rivero, A. Varela
Unidad Asistencial de Cirugía de Tórax. Hospital Nuestra Señora del Pino. Las Palmas de Gran Canaria
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Se presenta la experiencia en el tratamiento de los traumatismos penetrantes de tórax durante los años 1984 a 1989 en el Hospital Nuestra Sra. del Pino de Las Palmas de Gran Canaria.

En este período de tiempo se han atendido 55 pacientes afectos por heridas penetrantes torácicas. En 42 casos (76,5%) por arma blanca, en 12 (21,8%) por arma de fuego y en uno por un fragmento de cristal. En 39 ocasiones (70,9%), la herida ha sido torácica pura y en 9 (16,5%) ha sido toracoabdominal. En 4 (7,2%) ha habido afectación cardíaca y en 3 casos (5,4%), se trataban de heridas cervicotorácicas.

El hallazgo más frecuente ha sido el síndrome de ocupación pleural (neumotorax, hemotórax o hemoneumotórax), que se ha hallado en 50 ocasiones (90%) y que en general ha respondido bien al tratamiento con drenaje pleural. En 13 ocasiones (23,6%) se ha indicado cirugía urgente. Los criterios para adoptar dicha postura han sido la llegada del paciente en situación de hipovolemia o taponamiento cardíaco, la presencia de un hemotórax masivo o débitos altos por el drenaje pleural, la sospecha de rotura de la vía aérea y la presencia de cuerpo extraño intratorácico.

La morbilidad ha sido de 8 casos (14,5%) y no ha habido mortalidad intraoperatoria. Ha fallecido una paciente a los 30 días de su ingreso por un cuadro catatónico psiquiátrico.

La mayoría de heridas penetrantes responden correctamente al tratamiento con drenaje pleural. La. intervención quirúrgica se reserva para aquellos casos que llegan en mala situación clínica al hospital y cuando hay pérdidas aéreas y/o hemáticas importantes a través del tubo de drenaje pleural.

The experience with the treatment of penetrating thoracic in trauma in the Hospital Nuestra Sra. del Pino in Las Palmas de Gran Canaria is reported for the years 1984 to 1989.

During that time, 55 patients with penetrating thoracic wounds were seen. Forty-two patients (76,5%) had stab wounds, 12 (21,8%) had projectile wounds and in one the wound was caused by a glass fragment. In 39 instances (70,9%) the wound was thoracic alone and it was thoracoab-dominal in 9 (16,3%). In 4 (7,2%) there was cardiac involve-ment, and 3 (5,4%) were cervicothoracic wounds.

The most common finding was the pleural occupation syndrome (pneumothorax, hemothorax or hemopneumotho-rax), which was found in 50 instances (90%) and, as a rule, showed a good response to pleural drainage. In 13 instances (23,6%) emergency surgery was indicated. The criteria for this indication were hypovolemia or cardiac tamponade on presentation, massive hemothorax or high flow through pleural drainage, suspected airway rupture and the presence of an intrathoracic foreign body.

Morbidity were 8 cases (14,5%) and there was no intraope-rative mortality. A patient died 30 days after admission from a catatonic psychiatric disorder.

Most penetrating wounds have an adequate response to thoracic drainage therapy. Surgery should be reserved for those cases in a poor clinical condition on arrival to the hospital and when important air and/or blood leaks through the pleural drainage tube are present.

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Bibliografía
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Copyright © 1990. Sociedad Española de Neumología y Cirugía Torácica
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