The pulmonary hilum twist as a thoracic damage control procedure

Background Damage control techniques have been developed and applied to abdominal, vascular and thoracic injuries. Thoracic damage control techniques must be rapid and simple. Methods This report describes the successful use of pulmonary hilum twist as an effective damage control technique to control hemorrhage for severe lung trauma. Results The procedure involves division of the inferior pulmonary ligament then anterior rotation of the lower lobe over the upper lobe. The technique can be utilized in multiple settings including the emergency center, operating room, and during resuscitation. When vascular occlusion is maintained throughout resuscitation in the intensive care unit, pneumonectomy most likely will be required, but can be performed when the physiologic parameters have improved. Complications are similar to pneumonectomy and can include right-side heart failure, dysrrythmias, and hypoxia. Conclusions Pulmonary hilar twist is an effective technique that should be considered when a damage control approach is needed.