PURPOSE: Pneumothorax is a common complication of chest trauma that can progress rapidly to the life-threatening tension pneumothorax. Treatment of pneumothorax is tube thoracostomy insertion via 2nd or 5th intercostals spaces. We design this study to compare these two spaces for duration of hospitalization and rate of complication in Penetrating stab wound pneumothorax.
METHODS: In a randomized clinical trial the patients who had pneumothorax due to stab wound of the chest, were divided in two groups: group A tube thoracostomy in second anterior intercostals space and group B tube thoracostomy in mid axillary line of fifth intercostals space. Women, concomitant hemothorax in radiography or other chest injury that need surgery were excluded from this study. A single protocol was done for management of all patients.
RESULTS: overall 51 patients (26 case in group A, 25 cases in group B) were studied. According to statistical analysis there were no significant differences between 2 group in age, duration of air leak and complication rates. But there was significant difference between patients’ dissatisfaction about their operation scar and many of patients in group A were discontent about their exposed scars.
CONCLUSION: Although chest tube insertion from the highest points of the pleural cavity such as 2nd intercostals space theoretically accelerate gas exiting in pneumothorax and reduce air leak duration but there weren’t any significant difference in benefits or complications in simple pneumothorax when compared with 5th intercostals space (probably due to rapid and complete expansion of the lung).
CLINICAL IMPLICATIONS: We don’t recommend it as the initial treatment of penumothorax because not only it is not more effective but also its scar is more exposed. Nevertheless chest tube insertion in 2nd intercostals space may be useful in management of severe or persistent air leak in presence of non expandable lung (due to previous lobectomy or parenchymal fibrosis for example in TB), as the second tube thoracostomy especially when it used in combination with negative pressure.
DISCLOSURE: Hamid Hemmati, None.