Surgery>>>>>Trauma
Question 9#

Appropriate surgical management of a through-and-through gunshot wound to the lung with minimal bleeding and some air leak is:

A. Chest tube only
B. Oversewing entrance and exit wounds to decrease the air leak
C. Pulmonary tractotomy with a stapler and oversewing of vessels or bronchi
D. Wedge resection of the injured lung

Correct Answer is C

Comment:

Pulmonary injuries requiring operative intervention usually result from penetrating injury. Formerly the entrance and exit wounds were oversewn to control hemorrhage. This set the stage for air embolism, which occasionally caused sudden death in the operating room or in the immediate postoperative period. A recent development, pulmonary tractotomy, has been employed to reduce this problem as well as the need for pulmonary resection. Linear stapling devices are inserted directly into the injury tract and positioned to cause the least degree of devascularization. Two staple lines are created and the lung is divided between. This allows direct access to the bleeding vessels and leaking bronchi. No effort is made to close the defect. Lobectomy or pneumonectomy is rarely necessary. Lobectomy is only indicated for a completely devascularized or destroyed lobe. Parenchymal injuries severe enough to require pneumonectomy are rarely survivable, and major pulmonary hilar injuries necessitating pneumonectomy are usually lethal in the field.