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Penetrating injuries are defined as an injury that occurs

when a foreign object breaks through the skin and enters

the tissues of the body, creating an open wound. The

foreign object may either remain within the tissues, or be

retracted from the same entry wound, or may pass

through the entire depth of the tissues and exit through

another site.

These range of injuries are usually seen in combat-

associated injuries or violent crime-related injuries.

Mechanism of penetrating injuries are usually by gunshot

or stabbings. Assessment for penetrating injuries require

astute history taking, systematic clinical examination and

appropriate adjuncts such as X-ray and CT scan. Failure to

complete these steps may result in a missed finding and

may result in dire consequences.

Introduction

Case Report

References

He underwent a Median Sternotomy + Femoral-Femoral Bypass

+ Repair of SVC tear + Dacron grafting of the Brachiocephalic

Artery + Removal of the retained blade. Patient recuperated

well post op and was discharged home after 35 days

Conclusion

Penetrating injuries may appear subtle on initial presentation

but a thorough primary and secondary survey may expose a

more sinister presentation with critical outcomes if not

detected systematically and promptly. Especially penetrating

injuries in which clinical severity does not correspond to the

magnitude of mechanism of injury. In this case, had they not

completed the secondary survey with a Chest X-ray, this

patient would have been sent home with the blade still

concealed within!

Discussion

Thoracic injuries account for 20-25% of deaths due to trauma

and contribute to 25-50% of the remaining deaths. Improved

prehospital and perioperative care have resulted in an

increasing number of critically injured but potentially

salvageable patients presenting to trauma centers.

Injuries to the thoracic great vessels occur in about

5 % of gunshot wounds and 2 % of stab wounds to

the chest (12). Most of the victims reach the hospital

dead or in severe shock. The overall mortality of thoracic

aortic injuries is higher than 90 % and in subclavian vascular

injuries about 65 % (12, 13, 14). Many of these victims require

an emergency room thoracotomy (about 80 % of aortic injuries

and 23 % of subclavian vascular injuries) and the survival is

very poor.

Chest radiography remains the basis for initiating other

investigations. CT scanning is rapidly evolving into a primary

diagnostic tool because of its ability to image various

intrathoracic structures.

There has been an incremental increase in the utilization of

cardiothoracic surgeons over the last 10 years for thoracic

trauma operative intervention and with little data available,

it does appear to have resulted in improved patient outcomes.

1. Scandinavian Journal of Surgery 91: 41–45, 2002 PENETRATING INJURIES OF THE CHEST:INDICATIONS FOR OPERATION D.

Demetriades, G. C. Velmahos Department of Surgery, Division of Trauma and Critical Care, University of Southern

California, Los Angeles California, U.S.A

2. Penetrating Chest Trauma Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Jeffrey C Milliken, MD

3. Penetrating chest trauma (PMID:8432259) Jorden RC Department of Emergency Medicine, Maricopa Medical Center,

Phoenix, Arizona. Emergency Medicine Clinics of North America [1993, 11(1):97-106]

A 28 year old gentleman walked into the emergency

department of a district hospital after an alleged robbery in

his home.

Clinical examination showed multiple stab incision wounds

over Zone I of the left neck and left shoulder and upper

chest with minimal bleeding.

A CTA of the neck and thorax showed a stab wound injury

with embedded metallic blade traversing the left

supraclavicular region and superior mediastinum with the tip

of the blade appears to be within the right subclavian vein at

the level of its entrance into SVC.

.

1. Trauma Unit,General Surgery Department, Hospital Sultanah Aminah Johor Bahru

2. Cardiothoracic Unit, Hospital Sultanah Aminah Johor Bahru

3. Head of Unit, General Surgery Department, Hospital Sultanah Aminah Johor Bahru

K Abdulah 1, AM Khairi 1, Y Mohamed 1, RI Alwi 1, V Simon 2, AKB Gunn 3.

INJURED BY CONCEALED WEAPON

Entry wound

Metal bladeextracted

from body(21cm length)

(Chest X ray on arrival) (CTA image sagittal cut)