The technique of horizontal mattress suture closure of chest wall wound in penetrating chest trauma: Experience with 65 cases

Background: The treatment protocol for penetrating chest injury has not been previously documented in our setting for open pneumothorax. We decided to use the horizontal mattress suture closure (HMSC) because of the initial problems of using the traditional three taping method to abolish the open pneumothorax following penetrating chest injury. This retrospective study was to evaluate the effect of HMSC of open pneumothorax in penetrating chest trauma and to determine the outcome. Methods: We retrospectively examined 65 patients with open peumothorax following penetrating chest trauma treated at the Thoracic Surgery Unit of University of Port Harcourt Teaching Hospital and the Federal Medical Centre, Owerri between January 2012 and December 2014. We assessed the impact of HMSC on chest wound following penetrating thoracic trauma. Excluded were patient who required a thoracotomy. No ethical consideration was required for this retrospective study. Results: Sixty-five (25.4%) patients out of 256 who had chest trauma were managed for open pneumothorax following penetrating chest injury. There were 59 males and 6 females, aged 4-55 years (mean age, 29.9 ± 9.7 years). The causes of penetrating chest injury were gunshot injury in 44 patients (68%), stab injury in 20 patients (30%), and gunshot and stab injury in two patients (3%). The mean time between sustaining the injury and presentation at the emergency was 16.1 ± 34.2 h with 40 patients (61.5%) presenting within 12 h. Thirty-three patients had pneumohemothorax, 12 had only pneumothorax and 20 had subcutaneous emphysema with "sucking" chest wound and the sizes of the chest wall defects were between 3-8 cm. The mean volume drainage at the insertion of closed tube thoracostomy drainage was 724.4 ± 557.6 ml while the total drainage was 1115 ± 724 ml, three patients (4.6%) had empyema thoracis, three patients (4.6%) died and the total number of days on admission was 13.2 ± 7.8 days. The diagnosis of open pneumothorax was made by clinical evaluation of the patient. Conclusion: The technique of HMSC for open pneumothorax and insertion of a chest tube is a useful method for the treatment of penetrating chest injury and pleural fluid collections and, therefore, the method is recommended in well-selected patients.