Successful lung-preserving tractotomy to treat intrathoracic wood impalement after high-fall trauma: a case report

Background Thoracic impalement injuries caused by wooden objects are extremely rare and present unique diagnostic and therapeutic challenges owing to the radiolucent nature of wood and the risk of organic contamination. Lung-preserving tractotomy is a valuable, but infrequently reported technique for managing penetrating lung trauma caused by wooden foreign bodies. Case presentation A 39-year-old healthy arborist fell from a height of approximately 20 m during tree felling. On presentation, the patient was hemodynamically stable, with a small anterior chest wound and subcutaneous emphysema. Chest computed tomography (CT) revealed a 24 × 3 cm wooden foreign body completely embedded within the left lung, along with rib fractures and a moderate hemothorax. No vascular extravasation was observed. Emergency anterolateral thoracotomy was performed to avoid the risk of vascular injury and organic contamination. However, the wood fragments were firmly wedged between the ribs, rendering axial extraction impossible. Therefore, the object was exposed and safely removed using stapler-assisted tractotomy. Broad-spectrum antibiotics were administered, and the patient recovered uneventfully. He was discharged on postoperative day 18 and returned to full activity without complications. Follow-up CT at 8 months revealed complete resolution without evidence of empyema or atelectasis. Conclusions This case underscores the importance of comprehensive CT evaluation, avoidance of field extraction, and aggressive infection control in thoracic impalement injuries involving wooden objects. Tractotomy is an effective lung-preserving strategy that facilitates safe removal of deeply embedded wooden foreign bodies while avoiding the need for major pulmonary resection.