GSW chest

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Dear List,

I have a question regarding tractotomy for gunshot wound to the lung. I did
one the other day with one of my seniors who is not a dedicated trauma
surgeon. We used a GIA 80 stapler across the tract and opened it up nicely.
We managed to oversew all the bleeders and we left a dryish field. We
managed to oversew most of the major air leaks but we left a few small ones.
The senior I was with was not too concerned about these small leaks and said
that they would close on their own. The patient is still ventilated in ICU
with significant bubbling from the ICD on that side.

My question is whether you ALWAYS make the effort to make sure there is
absolutely no leakage of air across the injured tract or do you tolerate
small air leaks with the hope that they will close?

Thanks

Dean Lutrin
Surgical registrar
JHB, SA

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