Summary
The indication for thoracotomy is undisputed with gaping wounds and massive hemorrhage. Pericardial tamponade, however, can develop with discrete stab wounds. Since valuable time is lost during management of superficial wounds, the success of cardiac wound revision, which is usually possible withput a pump-oxygenator, is limited due to the tamponade-related reduction of cerebral perfusion and subsequent ischemic brain damage. Exploratory thoracotomy, the risks from which are small compared to those from pericardial tamponade, is generally indicated for stab wounds of the heart.
Zusammenfassung
Die Indikation zur Thoracotomie bei breit offenen Verletzungen und großen Blutung ist unumstritten. Diskrete Stichverletzungen verbergen jedoch häufig drohende Perikardtamponaden. Bei stabilen Kreislaufverhältnissen wird durch oberflächliche Wundversorgung wertvolle Zeit verschenkt, die den Erfolg der verzögerten gründlichen Revision der Herzverletzung, die meist ohne Herz-Lungen-Maschine möglich ist, durch Tamponade bedingte ischämische Hirnschädigung limitiert. Das Risiko einer explorativen Thoracotomie ist gegenüber dem Risiko einer plötzlich auftretenden Perikardtamponade bei Stichverletzungen der Herzregion niedrig, so daß die Indikation ur Thoracotomie großzügig gestellt werden sollte.
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Huth, C., Seboldt, H. & Hoffmeister, H.E. 19. Stichverletzungen der Herzregion - eine Indikation zur Thoracotomie. Langenbecks Arch Chiv 369, 125–128 (1986). https://doi.org/10.1007/BF01274336
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DOI: https://doi.org/10.1007/BF01274336