Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability

Schulz-Drost S, Grupp S, Pachowsky M, Oppel P, Krinner S, Mauerer A, Hennig F, Langenbach A (2017)

Publication Type: Journal article

Publication year: 2017

Journal

European Journal of Trauma and Emergency Surgery Springer Verlag (Germany)

Book Volume: 43

Pages Range: 169-178

Journal Issue: 2

DOI: 10.1007/s00068-016-0664-7

Abstract

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.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.

Authors with CRIS profile

Stefan Schulz-Drost Medizinische Fakultät Sina Grupp Unfallchirurgische Abteilung in der Chirurgischen Klinik Milena Pachowsky Unfallchirurgische Abteilung in der Chirurgischen Klinik Pascal Oppel Unfallchirurgische Abteilung in der Chirurgischen Klinik Friedrich Hennig Unfallchirurgische Abteilung in der Chirurgischen Klinik

Involved external institutions

St. Theresien-Krankenhaus Nürnberg DE Germany (DE)

How to cite

APA:

Schulz-Drost, S., Grupp, S., Pachowsky, M., Oppel, P., Krinner, S., Mauerer, A.,... Langenbach, A. (2017). Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability. European Journal of Trauma and Emergency Surgery, 43(2), 169-178. https://dx.doi.org/10.1007/s00068-016-0664-7

MLA:

Schulz-Drost, Stefan, et al. "Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability." European Journal of Trauma and Emergency Surgery 43.2 (2017): 169-178.

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