Penetrating injuries of the intrathoracic great vessels are well recognized although uncommon. In the First World War no survivors with thoracic vascular injury were recorded among soldiers treated with penetrating injuries to the chest as recorded by Makins. The first record of successful repair of a penetrating thoracic aortic injury was in 1922 by Dshanelidze in Russia. Similar to Makins' experience, De Bakey and Simeone in the Second World War recorded no surviving patients with involvem_ent of the thoracic aorta and its branches among American soldiers. Furthermore, no injuries to the thoracic aorta and its branches were recorded in Korean war soldiers undergoing vascular surgery by both Jahnke and Hughes. Rich reported 3 survivors of aortic injuries in the Vietnam war among 1000 patients with vascular injuries. By 1969 only 43 successfully treated cases had been reported but increasing numbers of patients sustaining injuries to the great arteries at the level of the thoracic inlet have been reported subsequently in civilian practice. Experience has grown over the years but patient numbers remain small and individual surgeons may only manage 2 or 3 of these patients in his life time. The largest single reported series consists of 93 patients in Memphis over a 13 year period. All victims were rapidly transported to hospital and were resuscitated en route. As a consequence, a large number critically ill patients reached hospital who may have died in earlier years. However some of these patients inevitably died in hospital contributing to the high mortality of 16, 7% reported. Our experience is different in that most of our victims who reach hospital will survive as poor community triage facilities prevent more than 95% of penetrating thoracic vascular trauma victims reaching hospital alive, hence we have a selection of less severely injured patients who eventually reach our hospital alive producing our mortality rate of 5%. Another important difference is that most of our patients suffered stab wounds as compared to gunshot wounds noted in the Memphis. Buchan and Robbs in Durban reported on 52 patients who had penetrating cervicomediastinal vascular injury with a remarkably similar experience to our own in Cape Town with the exception of a larger number of aortic injuries (21 out of 52 patients) recorded and a higher mortality rate of 17% as a result of these aortic injuries.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/26329 |
| Date | 06 April 2017 |
| Creators | Fulton, James Oliver |
| Contributors | De Groot, K M |
| Publisher | University of Cape Town, Faculty of Health Sciences, Division of Cardiology |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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