Can median sternotomy be comparable to anterolateral thoracotomy in the initial approach of patients with severe chest trauma?

Abstract text (incl. references and figure legends)
Introduction: Severe chest trauma represents an important cause of death of traumatic origin, only a minority of patients will require open surgical management and this can be initially performed through different incisions that allow rapid and effective stabilization according to current guidelines; the initial approach chosen may play an important role in the morbidity and mortality of this group of critically injured patients, there is concern that the median sternotomy may have inferior surgical results in the initial approach of patients with severe chest trauma compared with anterolateral thoracotomy, to address this gap in the literature, we conducted a review of cases presented in the last 9 years in a 1-level trauma hospital. Methods: A retrospective review of patients with systolic blood pressure less than 90mmHG who required emergency anterolateral thoracotomy versus patients who underwent an initial approach with median sternotomy between January 1, 2012, and December 31, 2021, included in this study was conducted. the trauma registry of the pan-american trauma society, at the clinic: Valle de Lili Foundation, Cali Colombia. Results: 123 patients were included, 10 patients underwent a median sternotomy and 113 patients underwent an anterolateral thoracotomy as the initial approach, no significant differences were found in the two groups in age, mechanism of trauma, ISS, RTS, TRISS, hospital stay and mortality (E: 1 (7.1%) vs T: 42 (16%) p-value 0.7). Conclusions: No evidence was found that median sternotomy is an inferior initial approach to emergency anterolateral thoracotomy in hemodynamically unstable patients with severe chest trauma.

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