Muscle-sparing versus standard posterolateral approach for urgent ‎thoracotomy in patients with traumatic thoracic injuries

Muscle-sparing thoracotomy (MST) has been proposed as an alternative to standard posterolateral thoracotomy (sPLT) for elective thoracic procedures with limited use in urgent thoracotomies. The aim of this study was to compare the results of sPLT and MST during urgent thoracotomy for the treatment of chest trauma. This case series study included patients who underwent urgent thoracotomies within the first 48 hours of admission for treatment of chest trauma, from January 2019 to July 2022. Patients were divided into two groups: sPLT and MST groups. In addition, the MST group was divided into partial (pMST) or complete (cMST).‎ Seventy-five out of 1400 patients with chest trauma (5.3%) underwent urgent thoracotomy, and 30 of them (40%) had MST. Compared with the sPLT group, the MST group had a lower abbreviated injury scale (AIS) of the thoracic region, with a significant difference (4.09 ± 0.66 versus 3.77 ± 0.72, P = 0.052). There was no significant difference between the two groups with regard to the duration of tube drainage, ICU stay, hospital stay, and postoperative complications. The length of hospital stay was shorter in the MST group with no statistically significant difference (14.30 ± 3.01 vs. 15.5 ± 2.48, P = 0.08). The extent of MST, whether partial or complete, had no significant effect on postoperative outcomes. If it does not impede access or chest exposure, MST can be performed with early recovery and therefore a shorter hospital stay than sPLT.