Multiple complex penetrating cardiac injuries: Role of civilian trauma in the education of the combat general surgeon

Objectives: To use a case report of a complex cardiac injury case to illustrate how civilian trauma can be used to train combat general surgeons. Case report: We report the case of a 23-year-old man who suffered three penetrating injuries to the left ventricle (LV) after multiple stab wounds to left chest. On hospital arrival he was conversant, hemodynamically stable, oxygenating well, and without signs of cardiac tamponade. He deteriorated and required an urgent exploratory thoracotomy. Intraoperatively, 2-, 3.5-, and 5-cm stellate lacerations were discovered in the LV near the aortic root, of which, two were full thickness. A simple pledgeted horizontal mattress suture was not sufficient to repair the injuries. The repair ultimately required a running polypropylene suture to control the hemorrhage. The patient was awake on postoperative day 0 and discharged on postoperative day 12 without significant complication. Conclusions: This case illustrates several points for the combat surgeon. First, young men are able to tolerate catastrophic injuries, presenting with normal hemodynamics. Second, there are a variety of techniques to use when treating uncommon injuries. Finally, the surgeon needs the ability to improvise quickly and to apply surgical techniques to treat complex traumatic injuries successfully.