Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability
| Autor: | Friedrich F. Hennig, Pascal Oppel, Andreas Langenbach, Milena L Pachowsky, Sebastian Krinner, A. Mauerer, Sina Grupp, Stefan Schulz-Drost |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Flail chest Rhomboid muscles Dissection (medical) Critical Care and Intensive Care Medicine Patient Positioning Fracture Fixation Internal 03 medical and health sciences Postoperative Complications 0302 clinical medicine Scapula Bone plate Flail Chest medicine Humans Minimally Invasive Surgical Procedures Orthopedics and Sports Medicine Prospective Studies Aged Aged 80 and over 030222 orthopedics Core (anatomy) Rib cage business.industry Latissimus dorsi muscle Pneumothorax 030208 emergency & critical care medicine Anatomy Middle Aged musculoskeletal system medicine.disease Surgery body regions Treatment Outcome medicine.anatomical_structure Emergency Medicine Female business Bone Plates Follow-Up Studies |
| Zdroj: | European Journal of Trauma and Emergency Surgery. 43:169-178 |
| ISSN: | 1863-9941 1863-9933 |
| Popis: | Stabilizing techniques of flail chest injuries usually need wide approaches to the chest wall. Three main regions need to be considered when stabilizing the rib cage: median-anterior with dissection of pectoral muscle; lateral—axillary with dissection of musculi (mm) serratus, externus abdominis; posterior inter spinoscapular with division of mm rhomboidei, trapezius and latissimus dorsi. Severe morbidity due to these invasive approaches needs to be considered. This study discusses possibilities for minimized approaches to the shown regions. Fifteen patients were stabilized by locked plate osteosynthesis (MatrixRib®) between May 2012 and April 2014 and prospectively followed up. Flail chest injuries were managed through limited incisions to the anterior, the lateral, and the posterior parts of the chest wall or their combinations. Each approach was 4–10 cm using Alexis® retractor. One minimized approach offered sufficient access at least to four ribs posterior and laterally, four pairs of ribs anterior in all cases. There was no need to divide latissimus dorsi muscle. Trapezius und rhomboid muscles were only limited divided, whereas a subcutaneous dissection of serratus and abdominis muscles was necessary. A follow-up showed sufficient consolidation. Complications: pneumothorax (2) and seroma (2). Minimized approaches allow sufficient stabilization of severe dislocated rib fractures without extensive dissection or division of the important muscles. Keeping the arm and, thus, the scapula mobile is very important for providing the largest reachable surface of the rib cage through each approach. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink