An empyema patient with a bronchopleural fistula who underwent right complete pleuropneumonectomy with extended thoracic wall resection and flail chest prevention involving a free thigh fascia

Objectives To characterize the clinical features among dogs sustaining rib fractures and to determine if age, type and severity of injury, entry blood lactate, trauma score and rib fracture score were associated with outcome. Methods A retrospective study was performed to include dogs that were presented with rib fractures. Risk factors evaluation included breed, age, body weight, diagnosis, presence of a flail chest, bandage use, puncture wound presence, rib fracture number, location of the fracture along the thoracic wall, hospital stay length, body weight, other fractures, pleural effusion, pulmonary contusions, pneumothorax and occurrence of an anaesthetic event. A retrospective calculation of an animal trauma triage (ATT) score, RibScore and Modified RibScore was assigned. Results Forty-one medical records were collected. Motor vehicular trauma represented 56% of the rib fracture aetiology, 41% of patients sustained dog bites and one case was of an unknown aetiology. Significant correlations with risk factors were found only with the ATT score. All patients that died had an ATT score ≥ 5. The ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% sensitive and 81% specific for predicting mortality. A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival. Mean hospital stay was 3 days longer for dog bite cases. Clinical Significance There was no increased mortality rate in canine patients that presented with the suspected risk factors. The only risk factor that predicted mortality was the ATT score.

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Long-term outcomes of surgical rib fixation in patients with flail chest and multiple rib fractures

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000546 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000546

Author(s):

Kenichiro Uchida ◽

Masahiro Miyashita ◽

Shinichiro Kaga ◽

Tomohiro Noda ◽

Tetsuro Nishimura ◽

...

Keyword(s):

Flail Chest ◽

Rib Fractures ◽

Thoracic Wall ◽

Long Term Outcomes ◽

Level Of Evidence ◽

Multiple Rib Fractures ◽

Rib Fixation ◽

Premorbid State

BackgroundRecently, interest has increased in surgical fixation for severe thoracic wall injury with good short-term outcomes. However, few reports have evaluated long-term outcomes or complications. This study aimed to assess long-term quality of life and implant-related complications after rib fixation for flail chest and multiple rib fractures.MethodsWe interviewed patients who had undergone rib fixation from January 2014 to December 2019 about their current ability to work and their usual life.ResultsTwenty-two patients underwent rib fixation during the study period. Two patients with flail chest had already died after the surgery due to senescence; thus, follow-up information was obtained from 20 patients (91%), with a follow-up duration of 47.5 (IQR 22–58) months. The most undesirable event occurring during the study period was irritation caused by a palpable plate (n=2, 10%), probably due to the thin skin of patients over 70 years old. Eighteen patients were able to return to their usual life or same work as in the premorbid state with no complaints. Two patients are still undergoing rehabilitation due to concomitant extremities fractures. The median EQ-5D-5L index score was 0.89 (IQR 0.84–0.93). There were no implant-related complications requiring plate explantation.DiscussionWe concluded that rib fixation offers good long-term benefits, with the ability of the patient with flail chest or multiple rib fractures to return to activity in the premorbid state. Elderly patients especially with thin, soft tissue may complain of irritation caused by the plate and should be informed of this prior to surgery.Level of evidenceLevel IV therapeutic care/management.

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The Impact of Chest Physiotherapy Technique (CPT) on Respiration, Pain and Quality of Life Post Thoracic Wall Fixation Surgery among Flail Chest Patients (FC)

American Journal of Nursing Research ◽

10.12691/ajnr-6-6-15 ◽

2018 ◽

Vol 6 (6) ◽

pp. 471-483

Author(s):

Hanan Gaber Mohamed ◽

Eslam I. Ragab ◽

Mohamed Abdel Bary ◽

Mahmoud Elshazly ◽

Ahmed Fathy Abdel Latif ◽

...

Keyword(s):

Quality Of Life ◽

Flail Chest ◽

Chest Physiotherapy ◽

Thoracic Wall ◽

The Impact

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Recurrent Intrathoracic Locking of the Scapula after Lung Cancer Resection and Combined Rib Resection

Case Reports in Orthopedics ◽

10.1155/2017/8486739 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Akinori Kimura ◽

Hideyuki Sasanuma ◽

Takashi Ajiki ◽

Hitoshi Sekiya ◽

Katsushi Takeshita

Keyword(s):

Lung Cancer ◽

Spindle Cell ◽

Three Dimensional ◽

Spindle Cell Carcinoma ◽

Primary Lesion ◽

Thoracic Wall ◽

Advanced Lung Cancer ◽

Lung Lobectomy ◽

Thoracic Wall Resection ◽

The Right

We report a case of recurrent locking of the scapula in the thorax after combined lobectomy and thoracic wall resection for advanced lung cancer. The patient was a 52-year-old man with advanced spindle cell carcinoma in his right lung. He had undergone right lung lobectomy and thoracic wall excision (Th1–5). Intrathoracic repair had not been performed to address the defect in the thoracic wall. Two months after the operation he experienced sudden acute pain in the right shoulder. Three-dimensional computed tomography revealed locking of the scapula intrathoracically. The diagnosis was recurrent locking of the scapula in the thorax. He underwent conservative treatment. Because his symptoms were not alleviated and he continued to experience recurrent locking, we performed partial resection of the inferior part of the scapula. Although scapular locking diminished after this procedure, there were still some pain and “catching” between the scapula and the thoracic wall (T6) when he undertook certain movements. No further surgery could be performed, however, because the cancer from the primary lesion had recurred near the previously operated thoracic wall. A procedure for recurrent intrathoracic locking of the scapula was not successful in this case.

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The Use of Polypropylene Mesh in the Reconstruction Techniques of the Thoracic Wall After Resections of the Thoracic Wall

Materiale Plastice ◽

10.37358/mp.17.4.4913 ◽

2017 ◽

Vol 54 (4) ◽

pp. 626-629

Author(s):

Bogdan Andrei Suciu ◽

Ioana Halmaciu ◽

Vasile Bud ◽

Constantin Copotoiu ◽

Decebal Fodor ◽

...

Keyword(s):

Retrospective Study ◽

Respiratory Failure ◽

Polypropylene Mesh ◽

Functional Results ◽

Thoracic Wall ◽

Surgical Interventions ◽

Paradoxical Movement ◽

Thoracic Wall Resection ◽

Viable Method ◽

Reconstructive Techniques

The thoracic wall resections for tumoral affections are laborious surgical interventions characterized by a high mortality and mobility. In order to create this paper we created a observational retrospective study in which we included 21 patients that have underwent parietal thoracic resections for tumoral affections. In all the patients we practiced the reconstruction of the thoracic wall using polypropylene mesh. The main postoperative complications were: seromas (14.28% of the cases), hematomas (9.52% of the cases), wound infection (4.76% of the cases), pneumonia (23.8% of the cases), respiratory failure (23.8% of the cases), paradoxical movement of the thoracic wall (52.38% of the cases). No deceases were recorded. In conclusion, the use of polypropylene mesh in the reconstructive techniques of the thoracic wall after thoracic wall resection represents a viable method, with good respiratory functional results.

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A simplified method for stabilization of flail chest injuries in small animals

Journal of the American Animal Hospital Association ◽

10.5326/15473317-31-2-137 ◽

1995 ◽

Vol 31 (2) ◽

pp. 137-141 ◽

Cited By ~ 8

Author(s):

JF McAnulty

Keyword(s):

Adverse Effects ◽

Flail Chest ◽

New Technique ◽

Thoracic Wall ◽

Small Animals ◽

Device Application ◽

Chest Injuries ◽

Rib Fixation ◽

Simplified Method ◽

A New Technique

Two dogs and one cat with flail chest injuries were treated by a new technique of external thoracic wall stabilization using a single circumcostal suture for each affected rib and a splint device. Application of the splint device was quick and required minimal manipulation of the patient. Stabilization of the flail chest resulted in improved respiration in each animal. The splint device was left in place in two of the animals as the sole means of rib fixation. No evidence of infection or other adverse effects were noted with this technique.

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Combined pulmonary and thoracic wall resection for stage III lung cancer.

Thorax ◽

10.1136/thx.50.7.782 ◽

1995 ◽

Vol 50 (7) ◽

pp. 782-784 ◽

Cited By ~ 21

Author(s):

S S Shah ◽

P Goldstraw

Keyword(s):

Lung Cancer ◽

Stage Iii ◽

Thoracic Wall ◽

Thoracic Wall Resection

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Rib Fracture Fixation, a new Era in Treatment of Chest Trauma in Albania

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v4i2.96 ◽

2020 ◽

Vol 4 (2) ◽

pp. 715-719

Author(s):

Fatmir ÇAUSHI

Keyword(s):

Pulmonary Function ◽

Chest Wall ◽

Motor Vehicle ◽

Flail Chest ◽

Rib Fractures ◽

Thoracic Wall ◽

New Era ◽

Vehicle Collision ◽

Fractured Ribs ◽

Maximal Medical Therapy

Rib fractures are a consequence of the forces of various arthritis that the chest wall and the thoracic cage itself undergo, and are most often due to closed injuries (eg, motor vehicle collision, falls from height, and Hits with strong objects ..), but penetrating injuries (eg, wounds with sharp tools, gunshot injuries ...) can also result in rib fractures. Non-operative treatment is based on pain control and pulmonary support, which mainly aim to avoid the need for intubation, which is associated with increased levels of pulmonary disorders until death. For patients who continue to have acute pain or instability of the chest wall (eg, flail chest), each of which impedes pulmonary function despite maximal medical therapy, or those with non-consolidating rib fractures and causing pain in the persistence and impairment of pulmonary function, surgicaly stabilization of fractured ribs, also known as osteosynthesis, are now well-known procedures that improve the quality of treatment of the traumatized patient. The thoracic wall injury association has been established to better study all aspects related to the consequences, diagnosis and treatment of thoracic wall injuries [1]. Indications for osteosynthesis, patient preparation, operative technique for stabilizing fractured ribs and the results are quite significant.

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