VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases

Gool, Matthijs H. van; Roozendaal, Lori M. van; Vissers, Yvonne L. J.; Broek, Robert van den; Vugt, Raoul van; Meesters, Berry; Pijnenburg, Annette M.; Hulsewé, Karel W. E.; Loos, Erik R. de

doi:10.1007/s11748-022-01830-6

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…The complications associated with selective intubation [ 23 , 24 ], one-lung ventilation, lateral decubitus positionning [ 25 , 26 ] and the consequence of perioperative fluid administration and transfusion must be weighed against the expected advantages of surgery. A muscle-sparing approach, less invasive than posterolateral thoracotomy, could be considered as suggested in a recent series [ 27 ]. Data from the literature on other postoperative respiratory outcomes are unclear.…”

Section: Discussionmentioning

confidence: 99%

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

Féray

Blayau

Masmoudi

et al. 2023

J Cardiothorac Surg

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Background The development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma. Methods We performed a retrospective observational cohort study describing the patients’ characteristics and analyzing the determinants of postoperative complications. Results From November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9–12], with 7 [5–9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12–3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02–1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication. Conclusion The TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

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Section: Discussionmentioning

confidence: 99%

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

Féray

Blayau

Masmoudi

et al. 2023

J Cardiothorac Surg

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“…The systematic use of thoracic video-assisted thoracoscopic surgery (VATS) exploration allows for clot removal, pleural irrigation, lung extrication and repair of pulmonary lacerations (31)(32)(33). In this series, VATS lead to the discovery and repair of undiagnosed diaphragmatic perforations in 7% of cases (from 1-5 cm), especially in patients with lower rib fractures involving ribs 7 to 10.…”

Section: Discussionmentioning

confidence: 99%

“…On admission to the ICU, median ISS and SAPS II were 32 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 24 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] respectively. After total body-CTscan; the median number of rib fractures was 7 [6][7][8][9][10].…”

Section: Lesions Descriptionmentioning

confidence: 99%

When to proceed to surgical rib fixation?—A single-institution clinical experience

Belaroussi¹,

Drevet²,

Soldea³

et al. 2023

J Thorac Dis

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Background: Surgical rib fixation for multiple rib fractures and flail chest has become more common in the 2000s with interesting results in selected patients. However, surgical rib fixation lacks a consensus on the delay to surgery and the benefits on postoperative clinical outcomes. Our goal was to determine if delay to surgery can affect postoperative outcomes. Methods:We analyzed a retrospective database including all consecutive patients referred for surgical rib fixation. All outcomes were explored according to trauma mechanism, associated lesions, initial ventilatory status, delay to surgery, surgical technique and a specific focus was made towards post-operative care and pulmonary complications. Logistic regressions were performed to evaluate the association between delay to surgery [before 48 hours (early group), 48 hours to 7 days (mid group), more than 7 days (late group)] and pneumonia and failure of extubating.Results: From 2010 to 2020, 159 patients underwent surgical rib fixation. The median hospital length of stay was 18 days [interquartile range 13-30]. Pulmonary infections were encountered in 67 patients (42.2%) with about two third of early pneumonia (<5 days). The one-month mortality rate was 1.9%. Delay to surgery was not associated with either pneumonia (P>0.05) or failure of extubating (P>0.05).Conclusions: Surgical rib fixation can be delayed without increasing the risk of pulmonary complications.Stabilizing other clinical situations can be safely prioritized if needed. A global evaluation including characteristics of trauma and lung evaluation must be considered before surgical stabilization of rib fracture.

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“…In the present study, the average time of wearing the external fixation guide plate for the patients was only approximately 30 days. Compared with the traditional internal fixation surgery, the rehabilitation time with this new technique was significantly shortened, and there was no requirement for secondary surgery after removing the guide, which reduced the surgical trauma and cost ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series

Hu,

Sun,

Bao

et al. 2023

Front. Surg.

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BackgroundFlail chest is a common and serious traumatic condition in thoracic surgery. The treatment of flail chest often includes open reduction and internal fixation, which is relatively traumatic, complicated, and expensive. As three-dimensional (3D) printing technology is widely used in the clinical field, the application of 3D-printed products to chest trauma will become a new treatment option. To date, the use of 3D-printed external fixation guides for flail chests has not been reported. Thus, we aimed to assess the short-term efficacy of a new technology that treated flail chests with an individualized 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery (VATS).Patients and methodsA retrospective analysis was performed on patients with flail chest treated with this new technique at our center from January 2020 to December 2022. The following parameters were included: operative time, thoracic tube extraction time, intensive care unit time, thoracic volume recovery rate, visual analog scale score 1 month postoperatively, and postoperative complication rate. All patients were followed up for at least 3 months.ResultsFive patients (mean age: 45.7 years) were enrolled; they successfully underwent surgery without chest wall deformity and quickly returned to daily life. The average number of rib fractures was 8.4; all patients had lung contusion, hemopneumothorax, and anomalous respiration. The abnormal breathing of all patients was completely corrected on postoperative day 1, and the chest wall was stable. One case experienced mild loosening of the 3D-printed guide postoperatively; however, the overall stability was not affected. The other four cases did not experience such loosening because we replaced the ordinary silk wire with a steel wire. All cases were discharged from the hospital 2 weeks postoperatively and returned to normal life 1 month after the removal of the 3D-printed guide on average. Only one case developed a superficial wound infection postoperatively, and no perioperative death occurred.ConclusionsThe 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery is a novel technique in the treatment of flail chest and is safe, effective, feasible, and minimally invasive, with satisfactory clinical efficacy.

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VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases

Cited by 7 publications

References 28 publications

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

When to proceed to surgical rib fixation?—A single-institution clinical experience

3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series

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