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Penetrating Stab Wounds

South African Medical Journal Penetrating Stab Wounds Of The Chest

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Penetrating stab wounds of the chest constitute an everpresent problem in many hospitals in South Africa. At Baragwanath Hospital, where approximately 1,500 cases are admitted annually, our experience in common with many other workers is that the mortality rate is steadily decreasing. Peace-time figures only are quoted, since war-time injuries involve tearing injuries by high velocity fragments as compared with the simple incised wound, common in peace-time. Representative mortality rates are: Boland' (1935) 13%, Elkin and Cooper' (1942) 62%, Skapinker" (1949) 6%, Gray et al: (1960) 3·8%, Garzan et al: (1964) 2%, and Baragwanath Hospital (1963) 1·6% (including those cases with thoraco-abdominal wounds who died during the postoperative period). The purpose of this paper is to discuss the factors operating in the patho-physiology of this condition and the treatment in relation to the patho-physiology, resulting in the lowered mortality rate.PATHO-PHYSIOLOGY IN PENETRATING WOUNDS OF THE CHEST Penetrating injuries of the chest produce ill-effects as a result of the following factors

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Clinical Study On Stab Wounds Of Chest–Factors That May Influence Their Mortality

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Abstract

Stab wounds of the chest occupy an important position in penetrating thoracic injuries in Japan. A retrospective review of 117 patients with stab wounds of the chest admitted to our hospital over the past 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. The management of intra-abdominal injuries was very important in thoracic stab wounds. Many of the patients with stab wounds of the precordial chest (danger zone) had cardiac or major vascular injuries, and the mortality rate of them was high. The mortality rate of the patients with stab wounds of the right lateral thorax was high, because many of them had trans-diaphragmatic liver injuries. We thought that right lateral thorax as well as precordial chest is the danger zone in thoracic stab wounds. Survival rate in the patients whose circulatory condition had been unstable when...

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Management Of Penetrating Stab Wounds Of The Chest: An Assessment Of The Indications For Early Operation.

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Abstract

Haemothorax, haemopneumothorax, and pneumothorax were the most common complications in 85 patients with penetrating stab injuries of the chest. These complications were amenable to conservative treatment by aspiration or drainage of the pleural space. Immediate operation was indicated in 30 cases. Indications for surgery were haemorrhage from a major systemic or pulmonary vessel or the heart, cardiac tamponade, diaphragmatic penetration, oesophageal and bronchial tears, and sucking chest wounds. The need for immediate operation was clinically obvious at presentation in most cases. It should have been suspected from the situation of the entry wound, the nature of the weapon used, the size of the haemothorax, and the clinical findings in the others. All 11 deaths occurred in that group in which early operation was indicated, and some could have been averted had the need for operation been suspected early. Seven patients developed an empyema; five were in the group...

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