The ABC of penetrating wounds: Indications for operative management of gunshot and stab injuries

Aim. Over the past twenty years the surgical approach to patients with penetrating injury changed completely and the results of the experience in the international literature have moved the management from the surgery in all patients towards a selective conservative treatment. Authors have reviewed their experience on penetrating wounds requiring surgery in the emergency department of a large metropolitan hospital in Rome. Methods. From January 2000 to December 2008 patients admitted at the tertiary level hospital Emergency Department DEA II Umberto I Policlinico di Roma requiring surgery for penetrating injuries were retrospectively reviewed and analyzed in order to define the diagnostic work-up and treatment adequacy on the basis of the results and worldwide guidelines and standard of care. Results. Ninety-three patients were admitted at the tertiary level hospital Emergency Department DEA II Policlinico Umberto I of Rome requiring surgery for penetrating injury. The surgical procedure performed were: 8 on the thorax (thoracotomy or thoracoscopy), 11 drainages of the pleural cavity, 23 laparotomies or operative laparoscopies, 8 vascular reconstructions, 2 arteriographies and 40 minor surgeries. The mortality rate was 1%. Conclusion. The "selective operative treatment" is suddenly becoming the standard of care in many traumatic emergencies following the philosophy of "Damage control.