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Baker E, Battle C, Lee G. Blunt mechanism chest wall injury: initial patient assessment and acute care priorities. Emerg Nurse 2024; 32:34-42. [PMID: 38468549 DOI: 10.7748/en.2024.e2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI.
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Affiliation(s)
- Edward Baker
- King's College Hospital NHS Foundation Trust, London, England
| | - Ceri Battle
- Swansea Bay University Health Board, Swansea, Wales
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England
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2
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Eriksson EA, Wijffels MME, Kaye A, Forrester JD, Moutinho M, Majerick S, Bauman ZM, Janowak CF, Patel B, Wullschleger M, Clevenger L, Van Lieshout EMM, Tung J, Woodfall M, Hill TR, White TW, Doben AR. Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1). Eur J Trauma Emerg Surg 2024; 50:417-423. [PMID: 37624405 DOI: 10.1007/s00068-023-02343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Surgical stabilization of rib fractures (SSRF) improves outcomes in certain patient populations. The Chest Wall Injury Society (CWIS) began a new initiative to recognize centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). We sought to describe incidence and epidemiology of SSRF at our institutions. METHODS A retrospective registry evaluation of all patients (age > 15 years) treated at international trauma centers from 1/1/20 to 7/30/2021 was performed. Variables included: age, gender, mechanism of injury, injury severity score, abbreviated injury severity score (AIS), emergency department disposition, length of stay, presence of rib/sternal fractures, and surgical stabilization of rib/sternal fractures. Classification and regression tree analysis (CART) was used for analysis. RESULTS Data were collected from 9 centers, 26,084 patient encounters. Rib fractures were present in 24% (n = 6294). Overall, 2% of all patients underwent SSRF and 8% of patients with rib fractures underwent SSRF. CART analysis of SSRF by AIS-Chest demonstrated a difference in management by age group. AIS-Chest 3 had an SSRF rate of 3.7, 7.3, and 12.9% based on the age ranges (16-19; 80-110), (20-49; 70-79), and (50-69), respectively (p = 0.003). AIS-Chest > 3 demonstrated an SSRF rate of 9.6, 23.3, and 39.3% for age ranges (16-39; 90-99), (40-49; 80-89), and (50-79), respectively (p = 0.001). CONCLUSION Anticipated rate of SSRF can be calculated based on number of rib fractures, AIS-Chest, and age. The disproportionate rate of SSRF in patients age 50-69 with AIS-Chest 3 and age 50-79 with AIS-Chest > 3 should be further investigated, as lower frequency of SSRF in the other age ranges may lead to care inequalities.
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Affiliation(s)
- Evert Austin Eriksson
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Drive CSB 420, MSC 613, Charleston, SC, 29425, USA.
| | - Mathieu Mathilde Eugene Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Adam Kaye
- Department of Trauma, Overland Park Regional Medical Center, 10500 Quivira Rd., Overland Park, KS, 66215, USA
| | - Joseph Derek Forrester
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Manuel Moutinho
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
| | - Sarah Majerick
- Department of Trauma, Intermountain Health, Salt Lake City, USA
| | - Zachary Mitchel Bauman
- Trauma Surgery, Surgical Critical Care, Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, TraumaOmaha, NE, 68198-3280, USA
| | - Christopher Francis Janowak
- Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA
| | - Bhavik Patel
- Gold Coast University Hospital, Gold Coast, QLD, 4215, Australia
| | - Martin Wullschleger
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Griffith University, Gold Coast, Australia
| | - Leanna Clevenger
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Drive CSB 420, MSC 613, Charleston, SC, 29425, USA
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jamie Tung
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Michelle Woodfall
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Thomas Russell Hill
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
| | | | - Andrew Ross Doben
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
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3
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Belyayev LA, Parker WJ, Madha ES, Jessie EM, Bradley MJ. Primary Lung Hernia After Blunt Chest Trauma: Chest Wall Repair Strategies. Am Surg 2023; 89:2073-2075. [PMID: 34096350 DOI: 10.1177/00031348211023439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung herniation is a rare pathology seen after trauma. A case of acquired lung hernia is presented after blunt thoracic trauma that was repaired primarily. Surgical management and decision-making for this process are discussed.
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Affiliation(s)
- Leonid A Belyayev
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - William J Parker
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Emad S Madha
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Elliot M Jessie
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Matthew J Bradley
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
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4
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Beloy V, Dull M. Blunt chest wall trauma: Rib fractures and associated injuries. JAAPA 2022; 35:25-31. [PMID: 36219110 DOI: 10.1097/01.jaa.0000885136.91189.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT Blunt injuries to the chest wall, specifically those related to rib fractures, need to be promptly identified and effectively managed to reduce patient morbidity and mortality. Furthermore, judicious use of multimodal pain management and early identification of patients who will benefit from the surgical stabilization of rib fractures are paramount to optimal outcomes.
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Affiliation(s)
- Victoria Beloy
- Victoria Beloy practices in general and trauma surgery at Intermountain Healthcare Good Samaritan Hospital in Lafayette, Colo. Matthew Dull is an acute care and trauma general surgeon at Spectrum Health Butterworth Hospital in Grand Rapids, Mich. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Elgar G, Smiley A, Latifi R. Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor. IJERPH 2022; 19:ijerph19148729. [PMID: 35886581 PMCID: PMC9318478 DOI: 10.3390/ijerph19148729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 02/05/2023]
Abstract
Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004–2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01–1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23–31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63–34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18–11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09–17.91, p = 0.038).
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Affiliation(s)
- Guy Elgar
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Correspondence: (G.E.); (A.S.)
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Correspondence: (G.E.); (A.S.)
| | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ 85724, USA;
- Ministry of Health, 10000 Pristina, Kosovo
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Wiesel O, Walden H, Nasti A, Patel K. Midline Approach for Surgical Stabilization of High Anterior Chest Wall Fractures. Isr Med Assoc J 2020; 22:584-586. [PMID: 33236560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Ory Wiesel
- Department of Surgery, Divisions of Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Heath Walden
- Department of Trauma and Critical Care, Maimonides Medical Center, Brooklyn, NY, USA
| | - Alexa Nasti
- Department of Surgery, Divisions of Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Krishan Patel
- Department of Trauma and Critical Care, Maimonides Medical Center, Brooklyn, NY, USA
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Lonardo MT, Frezzotti F, Collalti M, Natili A, Metere A. Spontaneous transdiaphragmatic intercostal hernia: clinical considerations and management. G Chir 2020; 41:99-102. [PMID: 32038019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most diaphragmatic ruptures are due to the traumatic or penetrating injury, while the spontaneous diaphragmatic rupture is considered uncommon. The spontaneous transdiaphragmatic hernia is a consequence of violent coughing, vomiting that increase the thoracoabdominal pressure causing the diaphragmatic rupture. Even rarer is the concomitant prolapse of abdominal viscera into the thoracic subcutis through the chest wall, a condition known as spontaneous transdiaphragmatic intercostal hernia. Herein, we present a rare case of spontaneous transdiaphragmatic intercostal hernia presenting as a thoracoabdominal emergency.
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Londe K, Patel N, Franga D. Traumatic Rupture of Diaphragm and Chest Wall Secondary to COPD Exacerbation. Am Surg 2019; 85:e421-e422. [PMID: 31560335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Janssen TL, Hosseinzoi E, Vos DI, Veen EJ, Mulder PGH, van der Holst AM, van der Laan L. The importance of increased awareness for delirium in elderly patients with rib fractures after blunt chest wall trauma: a retrospective cohort study on risk factors and outcomes. BMC Emerg Med 2019; 19:34. [PMID: 31195982 PMCID: PMC6567595 DOI: 10.1186/s12873-019-0248-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. METHODS A retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma- and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. RESULTS Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance. CONCLUSION Delirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.
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Affiliation(s)
- Ties L Janssen
- Department of surgery, Amphia Hospital Breda, P.O. Box 90518, 4800 RK, Breda, The Netherlands.
| | - Elmand Hosseinzoi
- Department of surgery, Amphia Hospital Breda, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Dagmar I Vos
- Department of surgery, Amphia Hospital Breda, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Eelco J Veen
- Department of surgery, Amphia Hospital Breda, P.O. Box 90518, 4800 RK, Breda, The Netherlands
| | - Paul G H Mulder
- Amphia Academy, Amphia Hospital Breda, Breda, The Netherlands
| | | | - Lijckle van der Laan
- Department of surgery, Amphia Hospital Breda, P.O. Box 90518, 4800 RK, Breda, The Netherlands
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10
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Cardentey-Oliva D, Herrera L, Safcsak K, Bhullar IS, Levitt A. Minimally Invasive Approach for Removal of a Bullet from the Thoracic Aortic Wall after Gun Shot Wound to the Chest. Am Surg 2018; 84:e434-e435. [PMID: 30269735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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11
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Fitzgerald MT, Ashley DW, Abukhdeir H, Christie DB. Chest Wall Stabilization Leads to Shortened Chest Tube Stay Time in Rib Fracture Patients after Traumatic Chest Wall Injury. Am Surg 2018; 84:680-683. [PMID: 29966568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rib fixation has become a strategy for patients with displaced rib fractures and hemo/pneumothoraces (HTX/PTX). Rib plating improves pain control and respiratory mechanics, thereby reducing recovery times and morbidity/mortality. Current treatment consists of chest tube placement, pain control, and pulmonary toilet. The addition of rib plating should reduce time till HTX/PTX resolution and chest tube removal. The study compares chest tube stay time in rib-plated patients with those managed with current treatment. We hypothesize that patients undergoing rib plating will have a reduction in chest tube stay times. A retrospective review of a Level 1 trauma registry was performed. Rib-plated patients (n = 70) from 2013 to 2015 were compared with a randomly selected, nonoperative, injury-matched, historical (2003-2008) control group (n = 60). Demographics were obtained. Independent variables analyzed include Injury Severity Score (ISS), intensive care unit days, length of stay, and chest tube stay times. 60 control patients had an average ISS of 19 and age of 51 years, compared with ISS of 20 and age of 56 years in plated patients. Plated patients had a reduction in chest tube days, 6.5 versus 8.4 days, P value = 0.02. Plated patients had 14 intensive care unit days versus 19 days, P value = 0.09. T tests were performed to confirm significance. Reduction in chest tube days improves patient pain and allows for improved ambulation and pulmonary toilet, helping reduce respiratory complications. Our review shows that plating may prove beneficial in reducing complications associated with management of HTX/PTX in the setting of rib fractures.
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Affiliation(s)
- Michael T Fitzgerald
- Department of Trauma Surgery and Critical Care, The Medical Center, Navicent Health, Mercer University School of Medicine, Macon, Georgia, USA
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12
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Neckelmann K, Hagelberg R. [Osteosynthesis of rib fractures, unstable chest wall, pseudoarthroses, and acquired defects of the chest wall]. Ugeskr Laeger 2018; 180:V06170455. [PMID: 29429475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Several patients suffer from rib fractures after traumas, and in severe cases it can be life-threatening. Until recently, attempts to perform surgical fixation in patients with instability have been unsuccessful. Chronic non-union causes persistent pain, disability and loss of quality of life. Implementation of surgical stabilization of rib fractures with tailored plates seems to improve pain relief, especially in cases of non-union but also in patients with instability of the chest wall after severe traumas, where advanced pain treatment (epidural catheter) is insufficient or weaning off fails.
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Abstract
This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms.
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Affiliation(s)
- Angela M Tegethoff
- Department of Emergency Medicine, Banner-University Medical Center Tucson, Tucson, Arizona, USA
| | - Emerald Raney
- Department of Emergency Medicine, Banner-University Medical Center Tucson, Tucson, Arizona, USA
| | - Jenny Mendelson
- Department of Emergency Medicine, Banner-University Medical Center Tucson, Tucson, Arizona, USA
| | - Michael R Minckler
- Department of Emergency Medicine, Banner-University Medical Center Tucson, Tucson, Arizona, USA
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Ferrell CL, Essman SC. What Is Your Diagnosis? Herniation of the left caudal lung lobe through the left seventh intercostal space. J Am Vet Med Assoc 2016; 248:759-61. [PMID: 27003014 DOI: 10.2460/javma.248.7.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shackelford R, Abdulsattar J, Aufman J, Madrid E, Cotelingam J, Hookim K. A Twenty-Three-Year-Old Man with a Chronic Anterior Chest Wall Wound, Eosinophilia, and Elevated IgE-Job's Syndrome. J La State Med Soc 2015; 167:186-188. [PMID: 27159513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 23-year-old man presented with a chronic anterior chest wall wound. Previously he had a split thickness skin graft in the area in where the wound bed had become infected, developing a thick purulent drainage. The infected skin graft was excised. Histologic examination of the failed graft revealed skin with surface ulceration, focal abscess formation, deep penetrating acute and chronic inflammation with numerous eosinophils, and granulomatous changes demonstrating a foreign body-type reaction to fungal hyphae (highlighted by periodic acid-Schiff staining, Figures 1A-E). The patient's past medical history included scoliosis, acute lower back pain, right shoulder degenerative joint disease, atopic dermatitis, lymphadenitis, rhonchi, insomnia, depression, and a long history of recurrent infections, particularly cutaneous staphylococcal and candida albicans infections, often accompanied by a purulent drainage. Review of the patient's laboratory studies revealed chronically elevated alkaline phosphatase, with highly elevated serum IgE (2,922 IU/ml) and eosinophilia (925/μL3) since childhood. Other lab studies were unremarkable, except for episodic elevations of the white blood cell count. The patient's family history was largely unremarkable and the patient's parents and siblings had no histories of unusual infections.
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Affiliation(s)
| | | | - J Aufman
- Department of Pathology, LSU Health Shreveport, LA
| | - E Madrid
- A medical student at the LSU Medical School Shreveport, LA
| | - J Cotelingam
- Department of Pathology, LSU Health Shreveport, LA
| | - K Hookim
- Department of Pathology, LSU Health Shreveport, LA
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Zhao JC, Xian CJ, Yu JA, Shi K. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn. Int Wound J 2015; 12:59-62. [PMID: 23490336 PMCID: PMC7950919 DOI: 10.1111/iwj.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/28/2013] [Indexed: 12/01/2022] Open
Abstract
Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.
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Affiliation(s)
- Jing-Chun Zhao
- Burns and Plastic Reconstruction Unit, the First Hospital of Jilin University, Changchun, China
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Tattoli L, Maselli E, Romanelli MC, Di Vella G, Solarino B. Complete cardiac rupture associated with closed chest cardiac massage: case report and review of the literature. J Forensic Sci 2014; 59:564-7. [PMID: 24749147 DOI: 10.1111/1556-4029.12340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35-year-old workman who collapsed and underwent ECM by his co-workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre-existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.
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Colville-Ebeling B, Freeman M, Banner J, Lynnerup N. Autopsy practice in forensic pathology - evidence-based or experience-based? a review of autopsies performed on victims of traumatic asphyxia in a mass disaster. J Forensic Leg Med 2013; 22:33-6. [PMID: 24485418 DOI: 10.1016/j.jflm.2013.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 09/30/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022]
Abstract
Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts.
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Affiliation(s)
| | - Michael Freeman
- Department of Forensic Medicine, Aarhus University, Denmark; Section of Forensic Medicine, Umeå University, Sweden; Department of Public Health & Preventive Medicine, Oregon Health & Science University, USA
| | - Jytte Banner
- Department of Forensic Medicine, Copenhagen University, Denmark
| | - Niels Lynnerup
- Department of Forensic Medicine, Copenhagen University, Denmark
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Lozano-Corona R, Loyola-Garcia U, Partida IC, Rodriguez-Ortega F. Successful treatment of flail chest with chondrosternal disruption and traumatic parasternal lung hernia with titanium rib bridges. BMJ Case Rep 2013; 2013:bcr2013008887. [PMID: 23608852 PMCID: PMC3645800 DOI: 10.1136/bcr-2013-008887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The surgical principles for the treatment of flail chest have yet to be fully established. Furthermore, the relationship between flail chest and lung hernias is unclear. We report here a rare case of chondrosternal traumatic disruption and lung hernia that was treated with a novel technique using titanium rib bridges and clips, which successfully reduced the hernia defect and provided stability to the chest wall. This procedure was beneficial in minimising the patient's ventilation time and time away from work.
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Affiliation(s)
- Rodrigo Lozano-Corona
- Department of Thoracic Surgery and Pneumology Service, General Surgery Service, Medical Center of Instituto de Seguridad Social del Estado de México y Municipios (ISSEMYM), San Jerónimo Chicahualco, Metepec, Estado de México
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Seleye-Fubara D, Etebu EN. Pathology of cause of death from penetrating weapons in the Niger Delta region of Nigeria: an autopsy study of 254 cases. Niger Postgrad Med J 2012; 19:107-110. [PMID: 22728977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIMS AND OBJECTIVES To study the pattern of death caused by penetrating weapons. This is a prospective autopsy study of 254 cases over 8 years (1995 - 2002) SUBJECTS AND METHODS A retrospective analysis of all the medico-legal autopsies performed by the authors on bodies in which the circumstances of death suggested the use of penetrating weapons over a period of 8 years was carried out by the authors. RESULTS A total of 254 bodies that died during close combat, communal clashes, militant attacks and armed banditry of penetrating weapons were recorded. The youngest was 2 years old male while the oldest was 75 years old male. The highest death toll occurred between the ages of 20-49 years 197(77.6% cases) with a peak at the age group 20 - 29 years 75(29.5%) cases. There were 218(85.8%) males and 36 (14.2%) females giving a male to female ratio of 6:1. The most common cause of penetrating death was gunshot missiles 136(53.5%), while the most common anatomic site of the wound was the chest wall 85(33.5%). Instant death occurred in 179(70.5%) cases and haemorrhagic shock caused the death of 229(90.2%) cases, while the brain was the most common organ lacerated 61(24.0%). CONCLUSION Penetrating wounds were commonly sustained in close combats, during communal clashes, militant and armed robbery attacks, and youth restiveness in the Niger Delta region of Nigeria. Guns which are prohibited by law and other sharp and pointed instruments were freely used. The condition is preventable by enforcing stringent laws, but it resulted into a lot of mortalities.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Autopsy
- Cause of Death
- Child
- Child, Preschool
- Female
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/mortality
- Head Injuries, Penetrating/pathology
- Homicide/statistics & numerical data
- Humans
- Male
- Middle Aged
- Nigeria/epidemiology
- Prospective Studies
- Retrospective Studies
- Sex Distribution
- Shock, Hemorrhagic/etiology
- Shock, Hemorrhagic/mortality
- Thoracic Wall/injuries
- Violence/statistics & numerical data
- Wounds, Gunshot/complications
- Wounds, Gunshot/mortality
- Wounds, Gunshot/pathology
- Wounds, Stab/complications
- Wounds, Stab/mortality
- Wounds, Stab/pathology
- Young Adult
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Affiliation(s)
- D Seleye-Fubara
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital PMB 6173, Port Harcourt, Nigeria.
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21
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Ashton-Cleary DT, Duffy MR. Prone ventilation for refractory hypoxaemia in a patient with severe chest wall disruption and traumatic brain injury. Br J Anaesth 2012; 107:1009-10. [PMID: 22088877 DOI: 10.1093/bja/aer374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Vyhnánek F. [Principles of the thoracic wall injury management]. Rozhl Chir 2011; 90:637-641. [PMID: 22442875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The overview presents the current situation in the diagnostics and therapy of unstable thoracic wall injuries. The diagnostic spectrum is enlarged by multidetector computed tomography with 3D reconstruction imaging in rib fractures. The use of MDCT in routine examination of blunt thoracic injuries proved to bet the most sensitive imaging method in rib fractures detection, including their dislocations and assessment of the extent of thoracic wall deformity. MDCT improves visualization of the thoracic wall injuries, thus facilitating assessment of the potential respiratory disorder significance. Non-surgical therapy is, as a standard, indicated in patients with thoracic wall injuries. The treatment includes respiratory tract hygiene, pain management and selective ventilatory support. Relative indications for surgical stabilization of fractures include block and serial rib fractures, thoracic deformities and defects and rib fractures healing disorders combined with other limiting criteria. Surgical stabilization is technically managed using metal or absorbable plasters. Surgery with open reduction and internal rib fixation, in particular in block or serial rib fractures, is associated with reduction of ventilation support time and reduction in the risk of infection.
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Affiliation(s)
- F Vyhnánek
- Traumatologické centrum FNKV, Chirurgická klinika FNKV a 3. LF UK, Praha.
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23
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Zhao R, Zeng A, Bai M, Qiao Q. [The reconstruction of large chest wall defect for 6 patients]. Zhonghua Zheng Xing Wai Ke Za Zhi 2010; 26:357-359. [PMID: 21174792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To introduce the management of large chest wall defect. METHODS From Oct. 2005 to Jun. 2009, 6 patients with large chest wall defects were reconstructed by latissimus dorsi muscle flap and titanium mesh in one case, reverse latissimus dorsi muscle flap and polypropylene mesh in one case, free lateral anterior thigh flap in one case, bilateral pectoralis muscle flap in one case, and vertical rectum abdominal muscle flaps in two cases. RESULTS The patients were followed up for 1-24 months with good cosmetic and functional results. The flaps survived completely. One case of chest wall fistula and one case of sinus occurred, which healed after debridement. CONCLUSIONS Every layers of chest wall defects should be reconstructed, respectively. The chest wall defects should be reconstructed by titanium mesh and polypropylene mesh first. The soft tissue defect should be covered with different flaps according to the location, area and the degree of the defects. Latissimus dorsi muscle flap can be as the first-line treatment with the advantages of good blood supply, flexible movement and abundant tissue volume.
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Affiliation(s)
- Ru Zhao
- Department of Plastic Surgery, Beijing Union Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100032, China
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24
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Forner G, Mengoli C, Fuser R, Scotton PG. Nocardiosis dissemination following transthoracic needle biopsy: two case reports. Infez Med 2010; 18:115-119. [PMID: 20610935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pulmonary nocardiosis is a rare respiratory infection whose diagnosis can easily be missed because there are no suggestive symptoms. Nocardiosis is typically regarded as an opportunistic infection, but one-third of infected patients are immunocompetent. We present two situations of pulmonary lesions in immunocompetent people. A CT-guided percutaneous transthoracic needle biopsy was performed in both cases but was not informative. Suppurative inflammation had developed as a complication of the procedure in the biopsy site after 1-2 weeks. Pus was aspirated and culture showed Nocardia spp. Therefore we hypothesize that the pulmonary lesion was caused initially by Nocardia which had subsequently disseminated to the chest wall after the biopsy. Treatment with trimethoprim/sulfamethoxazole was undertaken. Resolution of the disease was evaluated according to the clinical symptoms and radiological resolution after 6 months therapy.
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Affiliation(s)
- Gabriella Forner
- Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, Padua Italy
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Mayberry JC, Kroeker AD, Ham LB, Mullins RJ, Trunkey DD. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg 2009; 75:389-394. [PMID: 19445289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients' health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey. RAND-36 outcomes were compared with reference values from the Medical Outcomes Study and from the general population. Forty-six patients underwent acute chest wall repair between September 1996 and September 2005. Indications included flail chest with failure to wean from the ventilator (18 patients), acute, intractable pain associated with severely displaced rib fractures (15 patients), acute chest wall defect/deformity (5 patients), acute pulmonary herniation (3 patients), and thoracotomy for other traumatic indications (5 patients). Three patients had a concomitant sternal fracture repair. Fifteen patients with a current mean age of 60.6 years (range 30-91) responded to our surveys a mean of 48.5 +/- 22.3 months (range 19-96) postinjury. Mean long-term MPQ Pain Rating Index was 6.7 +/- 2.1. RAND-36 indices indicated equivalent or better health status compared with references with the exception of role limitations due to physical problems when compared with the general population. The operative repair of severe chest wall injuries is associated with low long-term morbidity and pain, as well as health status nearly equivalent to the general population. Both the MPQ and the RAND-36 surveys were useful tools for determining chest wall pain and disability outcomes.
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Affiliation(s)
- John C Mayberry
- Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Abstract
Chest wall lesions constitute a diverse group of thoracic diseases, including those of soft tissue and osseous origin. MR imaging, with its superior tissue-resolving capability and multiplanar image acquisition, is an important tool for assessing chest wall lesions. In this article, the authors review common and uncommon diseases of the chest wall, with an emphasis on the MR imaging characteristics of these diseases. Among the diseases they discuss are diseases of the soft tissue including lipoma, hibernoma, liposarcoma, hemangioma, and lymphoma. They also examine diseases of the osseous thorax, including benign osseous tumors, fibrous dysplasia, and aneurysmal bone cyst. In addition, they discuss such malignant osseous tumors as osteosarcoma and Ewing's sarcoma.
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Affiliation(s)
- Theodore J Lee
- Department of Radiology, University of California, San Francisco, San Francisco, California 94143, USA.
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Biswas S, Keddington J. Soft right chest wall swelling simulating lipoma following motor vehicle accident: transdiaphragmatic intercostal hernia. A case report and review of literature. Hernia 2008; 12:539-43. [PMID: 18293055 DOI: 10.1007/s10029-008-0342-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/11/2008] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Intercostal herniation of abdominal contents through a diaphragmatic defect is rare. We report a case of transdiaphragmatic intercostal hernia secondary to blunt trauma, initially misdiagnosed as lipoma, later confirmed by CT scan. METHODS We present a case of a 77-year-old who was involved in a motor vehicle accident and sustained a hand fracture. Later that year his wife noticed an egg-shaped soft swelling on his right chest wall. He was seen in the minor operative clinic, and a lipoma excision was attempted when it was found to be an intercostal hernia. Colon was seen in the hernial pouch. RESULTS Anatomically, the chest wall is weak from the costochondral junction to the sternum because of lack of external intercostal muscle support, and from the costal angle posteriorly to the vertebrae because of lack of internal intercostal musculature. The integrity of the thoracic cage is disrupted by tears of the intercostal musculature between fractured ribs. This defect leads to separation of the ribs and development of a potential weakened space for hernia. This chest wall muscular weakness can occur anywhere and can be more pronounced if it occurs at anatomically weakened areas. In the presence of associated diaphragmatic rupture, there is herniation of abdominal viscera. The treatment includes immediate surgical repair either by abdominal or thoracoabdominal approach. CONCLUSIONS A thorough physical examination may suggest the diagnosis, but confirmation by chest radiograph, CT scan, and sometimes by gastrointestinal contrast studies is often helpful for preoperative planning. A high index of suspicion for diaphragmatic injury or intercostal herniation during the initial evaluation, coupled with chest and abdominal diagnostic testing once the patient is stable, can avert undue delay in diagnosis and catastrophe from incarceration of a hernia.
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Affiliation(s)
- S Biswas
- Department of General Surgery, Stanford University Medical Center, 300 Pasteur Dr., H3591, Stanford, CA 94305-5641, USA.
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29
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Gong Z, Xu Z, Qin X. [Research on biocompatibility and in vivo degradation of biodegradable chest wall prosthesis materials in experimental animals]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007; 21:867-71. [PMID: 17882887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the biocompatibility and in vivo degradation of novel chest wall prosthesis materials and provide some data for their clinical application. METHODS According to the standard for the biological evaluation of the medical devices, several tests were performed to evaluate the tissue toxic effects induced by polydioxanone (Group A), chitosan (Group B), and hydroxyapitite/collagen (Group C), which were tested as component materials of the chest wall prosthesis. In the hemolysis test, 0.2 ml of the anticoagulant rabbit blood was added to the component materials and the normal saline (negative control) and to the distilled water (positive control). Five samples were made in each group. Absorbency was measured and the hemolysis rate was determined. In the acute systemic toxicity test, 20 mice were randomly divided into 4 groups (Groups A, B and C, and the normal saline group, n=5). The leaching liquid (50 ml/kg) was injected through the caudal vein, which was observed at 24, 48 and 72 hours. In the pyrogen test, 12 rabbits were randomly divided into 4 groups (Groups A, B, C and the normal saline group, n=3) the leaching liquid(10 ml/kg) was injected through the ear vein, and the body temperature was recorded within 3 hours. In the in vivo degradable test, the component materials (10 mm x 10 mm) were implanted in 12 rabbits at 2, 4, 8, 12, 16 and 24 weeks, respectively, after operation. Two rabbits were sacrificed for the macroscopic and the microscopic examinations. RESULTS The chest wall component materials had no hemolytic reaction, no acute systemic toxicity, and no pyrogen reaction. The results demonstrated that the implanted materials had only a mild inflammatory reaction during the early days of the grafting, which subsided gradually. There was no tissue denaturation, necrosis or pathological hyperplasia when the prosthesis materials were degraded. CONCLUSION The degradable materials of the chest wall prosthesis have a good biocompatibility and a great biological safety though their surgical application still requires a further clinical research.
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Affiliation(s)
- Zhiyun Gong
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University Shanghai, China.
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30
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Abstract
Full-thickness anterior chest wall burns result in contractures that may restrict the development of breast in young female patients. The management of postburn contractured anterior chest wall scars and unilateral breast hypoplasia with the expansion of bilayered artificial skin is herein presented for the first time in literature to the best of our knowledge. A 21-year-old female with chest wall contractures after thermal injury she had suffered at the age of 27 months was managed in three stages. The first stage included release and excision of contractures and scars, submuscular insertion of anatomical tissue expander, and coverage of the anterior chest wall with Integra artificial skin (Skin, Johnson & Johnson Medical, Division of Ethicon, Inc., Sommerville, NJ). One month later, the outer silicone layer of Integra was substituted by a split-thickness skin autograft and the expander was partly inflated with saline. During the third stage and after overexpansion of the expander had been completed, the expander was removed and a permanent silicone implant was subsequently inserted. No immediate or late complications were observed. At 17 months, the breast contour remains stable, no recontracture has occurred, and the patient evaluates the result as very satisfactory. Expansion of artificial skin Integra appears to be a reliable and safe alternative for reconstruction of the burned breast, lacking the morbidity associated with deep donor sites of full-thickness skin autografts or flaps.
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Affiliation(s)
- Dimosthenis Tsoutsos
- Department of Plastic Reconstructive Surgery, Athens General Hospital "G. Gennimatas," Athens, Greece
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Esme H, Solak O, Yurumez Y, Yavuz Y, Terzi Y, Sezer M, Kucuker H. The Prognostic Importance of Trauma Scoring Systems for Blunt Thoracic Trauma. Thorac Cardiovasc Surg 2007; 55:190-5. [PMID: 17410508 DOI: 10.1055/s-2006-955883] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early identification and aggressive management of blunt thoracic trauma are essential to reduce the significant rates of morbidity and mortality. The aim of this study was to evaluate the independent predictive value of 5 different trauma scoring systems (Revised Trauma Score [RTS], Trauma and Injury Severity Score [TRISS], Injury Severity Score [ISS], Lung Injury Scale [LIS], and Chest Wall Injury Scale [CWIS]) with respect to prognostic factors such as tube thoracostomy duration, the need for mechanical support and thoracotomy, the length of hospital and ICU stay, morbid conditions, and deaths of patients with blunt thoracic trauma. METHODS The records of 152 patients with blunt thoracic trauma were reviewed and data consisting of the patients' age and gender, blood pressure and respiratory rate on admission, the extent of chest wall and intrathoracic injury, types of associated injuries, Glasgow Coma Scale (GCS) scores, the need for mechanical support and thoracotomy, tube thoracostomy duration, length of hospital and ICU stay, morbid conditions, and deaths were collected. The relations between the trauma scoring systems and prognostic factors were evaluated by multivariate analysis. RESULTS The analysis showed that only TRISS was an independent predictor of mortality and only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay. CONCLUSIONS The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients.
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Affiliation(s)
- H Esme
- Department of Thoracic Surgery, Afyon Kocatepe University, School of Medicine, Afyon, Turkey.
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Affiliation(s)
- Mark S Link
- Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts
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Abstract
We report the case of a 25-year-old African-American man presenting to the Henry Ford Hospital emergency department with acute dyspnea secondary to a pneumothorax resulting from a migratory acupuncture needle. The patient received acupuncture treatment approximately 5 years prior to this presentation for treatment of posttraumatic chronic right shoulder pain. Chest radiography revealed retained needles in his right shoulder girdle and a needle overlying the thoracic cage with an attendant pneumothorax. Catheter aspiration for simple pneumothorax provided immediate symptomatic relief. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle from the chest wall. The patient recovered without complication and was discharged to home.
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Affiliation(s)
| | - Mark K Baker
- Department of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, MI
| | - Robert J Brewer
- Department of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, MI
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Chen JK, Johnson PT, Fishman EK. Multidetector row CT detection of a post-traumatic chest wall pseudoaneurysm. Emerg Radiol 2007; 13:191-3. [PMID: 17211675 DOI: 10.1007/s10140-006-0539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer K Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3254, 601 North Caroline Street, Baltimore, MD 21287-0801, USA.
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Schellhammer F, Wild M, Fürst G. Skapulothorakale Dissoziation mit letalem Ausgang. ROFO-FORTSCHR RONTG 2007; 179:82-3. [PMID: 17203447 DOI: 10.1055/s-2006-927190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abakumov MM, Voskresenskiĭ OV, Zhestkov KG. [Thoracoscopy in the treatment of intrapleural bleeding due to injury of chest wall vessels]. Khirurgiia (Mosk) 2007:4-9. [PMID: 17495823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Thoracoscopy was used in the treatment of 141 patients with penetrating wounds of chest. Injuries of chest wall vessels were diagnosed at 68 (48.2%) patients. Rate of thoracoscopy conversion due to bleeding from chest wall wounds was 4.3%. Thoracoscopy is effective at injuries of intercostals arteries and their muscular branches, but injuries of internal thoracic artery require conversion into thoracotomy at 50% cases. It is revealed that expediency of thoracoscopy is in direct proportion to time from injury point and is inversely to hemothorax volume.
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Phelan HA, Patterson SG, Hassan MO, Gonzalez RP, Rodning CB. Thoracic damage-control operation: principles, techniques, and definitive repair. J Am Coll Surg 2006; 203:933-41. [PMID: 17116562 DOI: 10.1016/j.jamcollsurg.2006.08.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 08/09/2006] [Accepted: 08/14/2006] [Indexed: 11/25/2022]
Affiliation(s)
- Herb A Phelan
- Department of Surgery, Division of Trauma/Critical Care, University of South Alabama Medical Center, Mobile, AL 36617, USA.
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Vodicka J, Safránek J, Spidlen V, Veselý V, Ferda J, Louda J. [Reconstruction of a crushed chest with HI-TEX PARP NT implant]. Unfallchirurg 2006; 110:255-8. [PMID: 17048025 DOI: 10.1007/s00113-006-1176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors present the case of a 57-year-old man with polytrauma, who was injured in a train accident. Together with other injuries, he also sustained multiple comminuted fractures on the left half of the rib cage. These subsequently required surgical intervention because of thoracic instability and impending lung injury. Extensive damage to the thoracic skeleton was treated by removal of the damaged tissues and replacement by the HI-TEX PARP NT implant. The presented procedure is being discussed as an alternative to metallic fixation in thoracic instability in cases of devastating injury or injury resulting in bone and tissue loss.
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Affiliation(s)
- J Vodicka
- Chirurgische Klinik, Universitätskrankenhaus, Alej Svobody 80, 30460 Pilsen, Czech Republic.
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Strecker T, Feyrer R, Horch RE, Weyand M, Kneser U. Simultaneous heart valve replacement and reconstruction of the radiation-damaged chest wall with a delayed vertical rectus abdominis myocutaneous flap. J Thorac Cardiovasc Surg 2006; 132:980-1. [PMID: 17000321 DOI: 10.1016/j.jtcvs.2006.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 04/22/2006] [Accepted: 05/17/2006] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Strecker
- Center of Cardiac Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
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Das Adhikari D, David SS, Kumar G R. Scapulothoracic dissociation--A case report. J Indian Med Assoc 2006; 104:334-5. [PMID: 17058554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Scapulothoracic dissociation (SCTD) is a rare clinical entity with fewer than 70 cases reported in English literature. The mechanism of injury is severe rotational force, which causes disruption of the shoulder girdle from the rest of chest wall. Frequently, SCTD produces massive blood loss as it involves major fractures of the upper extremity, disruption of muscle, brachial plexus, and vascular damage. This case report demonstrates classical radiological findings of SCTD with brachial plexus injury but with no associated vascular damage.
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Affiliation(s)
- Debasis Das Adhikari
- Department of Accident and Emergency Medicine, Christian Medical College and Hospital, Vellore 632004
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Duan L, Xu ZF, Zhao XW, Gong ZY, Sun K, Qin X, Fang J. [Experimental study of degradable chitin long fiber reinforced polycaprolactone for reconstruction of chest wall defects]. Zhonghua Wai Ke Za Zhi 2006; 44:665-7. [PMID: 16784673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the application of a novel degradable biomaterial as a chest wall prosthesis and provide valuable scientific basis for clinical application. METHODS Preparation of chitin long fiber reinforced polycaprolactone (PCL) by means of melt blending and modeling. Full-thickness chest wall defects of 10 cm x 8 cm was created in 10 dogs and then repaired with long chitin fiber reinforced PCL artificial rib in 8 dogs (tested group) and Marlex mesh in 2 dogs (control group). It was dynamically observed that the situation of the implanted chest wall prosthesis and the progress of the regeneration of the chest wall tissue postoperatively. RESULTS No operative and perioperative deaths were observed in all experimental dogs. In tested group, slight paradoxical respiration occurred in 2 dogs and could not be seen in 2 weeks. No chest wall subsidence and infection occurred. New bone tissue obviously regenerated around both resection ends of the ribs and integrated tightly with artificial ribs. In control group, there were evidently paradoxical respiration and chest wall subsidence. Marlex mesh folded and was enveloped by fibrous tissue. CONCLUSION Degradable chitin long fiber reinforced PCL can provide effective support to chest walls and is a practicable material for chest wall reconstruction.
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Affiliation(s)
- Liang Duan
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Affiliation(s)
- Ronald I Gross
- Trauma Program, Hartford Hospital, Hartford, CT 06102, USA.
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Weinstock J, Maron BJ, Song C, Mane PP, Estes NAM, Link MS. Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis. Pediatrics 2006; 117:e656-62. [PMID: 16510614 DOI: 10.1542/peds.2005-1270] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sudden cardiac death that results from chest wall blows (commotio cordis) the second leading cause of death in young athletes. Most events are caused by blows from projectiles, such as baseballs or lacrosse balls, with a substantial proportion occurring despite the use of a chest protector. In the present experiment, we tested the effectiveness of commercially available chest protectors in preventing ventricular fibrillation (VF) that results from chest wall strikes with baseballs and lacrosse balls. METHODS Twelve different baseball or lacrosse chest protectors were evaluated in juvenile swines that were subjected to 40-mph baseball or lacrosse ball blows to the precordium during the vulnerable period of repolarization for VF and were compared with control impacts without chest protectors. Seven baseball chest protectors were hit by regulation baseballs, and 5 lacrosse chest protectors were tested by blows with standard lacrosse balls. Each animal received 2 chest blows for each protector and 2 control impacts without a chest protector, with the sequence of impacts assigned randomly. RESULTS VF was elicited by 12 (32%) of 37 strikes in control animals without baseball chest protectors. None of the baseball chest wall protectors tested were shown to decrease significantly the occurrence of VF when compared with controls. VF was elicited by 11 (46%) of 24 strikes in control animals without lacrosse chest protectors. None of the lacrosse chest wall protectors tested decreased significantly the occurrence of VF when compared with controls. CONCLUSION In our experimental animal model of commotio cordis, commercially available baseball and lacrosse chest wall protectors were ineffective in protecting against VF that was triggered by chest blows and, by inference, sudden cardiac death. Improvements in materials and design of chest wall barriers are necessary to reduce the occurrence of these tragic events and make the athletic field safer for youths.
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Affiliation(s)
- Jonathan Weinstock
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA
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Abstract
Penetrating injuries involving the spinal cord are not common. The incidence is, however, much higher in armed conflict. In a civilian population, gunshot wounds and stabbings account for the majority of such injuries. A pencil causing penetrating injury involving the spinal cord is very rare. We present the case of a young boy who accidentally suffered a penetrating injury involving the spinal cord from a pencil in his coat pocket.
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Affiliation(s)
- Wendy A Frye
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, WI 54601, USA
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Abstract
A 37 year old man was found collapsed at the roadside and taken to the emergency department. Communication was difficult, as the patient could not speak English. There was a wound in the left second intercostal space on the midclavicular line, which was bleeding and was bubbling air. A drain was inserted, bleeding controlled, and his wounds sutured. Chest x ray later confirmed satisfactory placement of the drain. The following day, swelling and discharge indicated oesophageal damage, which was later confirmed by gastrografin swallow. With conservative management in hospital for 2 weeks, he made a full recovery and was discharged.
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Affiliation(s)
- A Jabbar
- St. James' Hospital, Dublin, Ireland.
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Pereira C, Sterns A, Sanford A. Skin substitute jacket for burns to the trunk. Burns 2005; 31:800-1. [PMID: 15993002 DOI: 10.1016/j.burns.2005.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
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Abstract
Central line complications are common, and extravasation injuries related to infusion of caustic substances have been previously described. Although hydrochloric acid has been used for many years to treat metabolic alkalosis, there have been no reported fatal complications. We report the case of a 53-year-old female who received a fatal chemical burn due to extravasation from a subclavian central venous catheter of hydrochloric acid infused to correct severe metabolic alkalosis. This case illustrates the hazards of the infusion of caustic substances through central lines and underscores the importance of constant vigilance regarding line positioning and changes to the surrounding tissues when infusing these substances.
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Affiliation(s)
- Ian B Buchanan
- North Carolina Jaycee urn Center, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7228, USA
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Affiliation(s)
- Pedro Costa Ferreira
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital de São João, Porto Medical School, Porto, Portugal.
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Tan Z, Nirmal L, Liu D. [Reconstruction of chest wall after resection]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2005; 19:338-40. [PMID: 15960432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To evaluate the results of chest wall reconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. METHODS From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years. The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiation necrosis 1 and skin cancer 1. The number of rib resected was 2-7 ribs (3.6 in average). The defect was 20-220 cm2 (97.1 cm2 in average). Concomitant resection was done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternotomy 1. Seven patients underwent soft tissue reconstruction alone (latissimus dorsi+greater omentum, latissimus dorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone (Prolene web), and simultaneous BR and STR were performed in 19 patients (latissimus dorsi, pectoralis major, latissimus dorsi+fascia lata, and Prolene web). RESULTS Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6-57 months with a median of 22 months. CONCLUSION A favorable clinical outcome can be achieved by CWR for the patients with huge chest wall defects that result from resection of chest wall tumors.
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Affiliation(s)
- Zhenbo Tan
- Department of Thoracic Surgery, Xingtai People's Hospital, Xingtai Hebei, 054031, PR China.
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