VACUUM ASSISTED STABILIZATION OF FLAIL CHEST – A COMPARATIVE CASE CONTROL PILOT STUDY
Flail chest is associated with high rates of morbidity and mortality and management of such condition is a multidisciplinary task that should be based on pain control, judicious fluid administration, adequate pulmonary hygiene and management of the paradoxical movements of the thoracic wall. Many methods of treating rib fractures and flail chest have been developed over the years. Our aim was to evaluate a novel method of flail chest stabilization using negative vacuum pressure and compare it to a traditional method. Material and methods: 10 patients with flail chest from trauma admitted in Thoracic Surgery Clinic from Clinical County Emergency Hospital of Craiova and County Emergency Hospital of Targoviste were submitted to stabilization using Vacuum Assisted Closure kit. This series of patients were compared with 10 patients in whom a traditional method of stabilization was used, selected from the database of patients from the Thoracic Surgery Clinic of Clinical Emergency Hospital of Craiova, used as control group. Results: The 2 groups were comparable as no statistically significant differences were found regarding the gender, mean age, type of trauma, associated trauma, preexistent conditions, number of rib fractures, presence of pulmonary contusion, thoracic deformity. The parameters investigated: number of days with mechanical ventilation, number of days spent in ICU, total hospital stay, mortality didn’t reach statistically significant differences. The only significant results found were for the pain scores recorded at 2 weeks and 1 month after discharge, the VAC stabilization being significantly better than traditional method. Conclusions: A larger study is required to establish if the advantages of the VAC assisted stabilization of the flail chest are superior to traditional treatment.
2. Shields TW, LoCicero J III, Ponn RB, Rusch VW. General Thoracic Surgery, 6th Edition, Philadel-phia: Lippincott Williams & Wilkins, 2005.
3. Crisci R, Divisi D. Chest wall surgical stabilization after thoracic trauma: indications and techniques. Shanghai Chest 2017; 1: 5 / doi: 10.21037/shc.2017.05.04
4. Hameed A, Akhtar S, Naqvi A, Pervaiz ZJ. Reconstruction of complex chest wall defects by using polypropylene mesh and a pedicled latissimus dorsi flap: a 6-year experience. Plast Reconstr Aesthet Surg 2008; 61(6): 628-635.
5. Paleru C, Marinescu L, Popescu V. P-227 non-operative external fixation of flail chest using vacuum-assisted therapy Interactive Cardiovascular and Thoracic Surgery 2017; 25(Suppl_1), ivx280. 227 / doi.org/10.1093/icvts/ivx280.227.
6. Gimpel D, Niamh Ni Leathlobhair NN, Joseph Conway J. External stabilization with vacuum assisted contrivance (ES-VAC) for chest wall injuries sustained from cardiopulmonary resuscitation. Re-suscitation 2019; 137: 49-51 / doi: 10.1016/j.resuscitation.2019.01.028.
7. Winge R, Berg JO, Albret R, Krag C. VAC® for external fixation of flail chest. Clin Pract 2012; 2(3): e65 / doi:10.4081/cp.2012.e65
9. Buckwalter JA, et al. Healing of the musculoskeletal tissues, in Rockwood and Green’s Fractures in Adults (Rockwood CA, et al., editors) Philadelphia: Lippincott-Raven, 1996, 261-304.
10. McKibbin, B. (1978) The biology of fracture healing in long bones. J Bone Joint Surg Br 1978; 60B(2): 150-162.
11. Hollinger J, Wong ME. (1996) The integrated processes of hard tissue regeneration with special emphasis on fracture healing. Oral Surg. Oral Med. Oral Pathol. Oral Radiol Endodont 1996; 82(6): 594-606.
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
N.B. All the authors must sign this form