Operative Management of Lung Injuries

The need for operative management of pulmonary injury is uncommon. However, delaying patients requiring a thoracotomy for trauma increases morbidity and mortality; thus, the key aspect in management in this patient population is timely an operative intervention. Once the decision is made to perform a thoracotomy, the goal is to obtain control of hemorrhage as soon as possible. Lung lacerations from penetrating trauma usually have a tract though the pulmonary parenchyma and are usually amenable to lung-sparing techniques such as tractotomy or limited resections. Injuries from blunt trauma usually result in more significant tearing of the lung and are more likely to require larger resections. With modern approach to resuscitation, it is more important to quickly control hemorrhage than to worry about removing “too much lung.” Damage control techniques including temporary hilar clamping and chest packing are useful adjuncts to achieve survivorship in those patients with extensive chest trauma. © 2015, Springer International Publishing AG.