Changing dogmas: history of development in treatment modalities of traumatic pneumothorax, hemothorax, and posttraumatic empyema thoracis

Development of treatment modalities for chest wounds and traumatic empyema thoracis is reviewed in the light of war experience. Mortality from thoracic injury was more than 50% before World War I and was about 25% during World War I. It came down to 10% in World War II and was about 5% during the Korean War. It improved further during the Vietnam War, until it ranged at 2% to 4%, where no further improvement could be imagined. Thoracic surgery was born in the field hospitals of World War I. Established drainage methods and standardized anesthesia made thoracotomy a standard procedure in World War II. As experience increased in chest trauma, surgical aggression diminished. Drainage ruled primary chest trauma treatment algorithms during the Vietnam War and coexisted with the full arsenal of cardiothoracic surgery when it was needed. Optimization of thoracic surgical aggression includes a case-tailored approach when major chest surgery with or without interventions on the central cardiovascular system is needed. This is where we are now, provided a proper logistic, Medevac system exists. If we let the past fade away, the danger of committing the mistakes of our predecessors increases without having their excuses. Our present is only the past of the future.