Penetrating wounds to the posterior chest: analysis of exigent thoracotomy and laparotomy.
Most reports of penetrating chest wounds include all regions of the thoracic wall. Recent studies of abdominal wounds stratified by entrance site have demonstrated significant differences in injury pattern that influence initial assessment and management. This is an analysis of 135 consecutive patients admitted to the Denver General Hospital with penetrating injuries to the posterior chest, done in an effort to elucidate operative indications. Fifteen of these patients required emergency department (ED) thoracotomy and were excluded from the study. In the remaining 120 patients, mechanism was gunshot (GSW) in 20% and stab wound (SW) in 80%; 89% were men, and the mean age was 26 years. For analysis, the posterior chest was further divided into upper and lower at the inferior tip of the scapula line. Overall, 28 patients (23%) with posterior penetrating chest wounds required early surgical intervention; 38% following a GSW compared to 20% due to a SW. Only 9 patients (8%) required thoracotomy while 19 (15%) underwent laparotomy. The most frequent indication for thoracotomy was persistent chest hemorrhage, and for laparotomy, positive diagnostic peritoneal lavage.