INTRODUCTION
Blunt chest injury is the most common among all chest traumas. Most of these injuries need only conservative treatments such as bed rest and pain relief. However, when accompanied with haemothorax and pneumothorax, additional management strategies may be needed [1, 2]. The majority of these pleural collections could be diagnosed by chest images during initial surveys and most of them could be managed successfully by tube thoracostomies only [3–5].
Computed tomography (CT) is a tool used in surveys of chest wall injuries and lung parenchymal injuries [3, 4, 6]. There are three types of lung parenchymal lacerations classified by Wagner et al. [3] according to their locations and trauma mechanisms (Table 1). The type III laceration is located peripherally because it is usually associated with rib fractures (Fig. 1). This lesion is an important factor in the induction of haemothorax and pneumothorax [4]. Accompanied with chest tube obstructions, retained pleural collections could occur. Further surgical intervention(s) should be considered to prevent post-traumatic complications [7, 8].
Table 1: Wagner's classification for lung laceration diagnosed from computed tomography
Type I Centrally located lesion, produced from shearing between the lung parenchyma and the tracheobronchial tree
Type II Tubular lesion, located at the lower lobes; the lower chest is suddenly compressed, squeezing the lower lobes against the vertebral bodies
Type III Small, rounded and peripherally located, frequently associated with rib fractures and pneumothorax
Type IV Shearing of the lung from traction of previously formed pleuropulmonary adhesions over the parenchyma
Figure 1: A patient has left-sided multiple rib fractures with haemothorax and pneumothorax. Two lacerations of the lung parenchyma could be noted on computed tomography (arrows).
Video-assisted thoracoscopic surgery (VATS) has become a practical reality in chest surgery since 1990, due to the advances in endoscopic technology [9–11]. Thoracic surgeons use VATS in the treatment of retained haemothorax or pneumothorax; however, some thoracic surgeons have focused on adequate drainage without management of lung parenchymal injury, while others have advanced the procedure to repair lung lacerations along with adequate drainage. The objective of this study was to find out if there is any advantage in repairing or resecting traumatic lung laceration to reduce the incidence of infections, with any benefits in terms of patient clinical outcomes.