FLAIL CHEST
Abstract
Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.
Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.
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References
Jurkovich GJ, Carrico CJ. Trauma. Management of the acutely injured patient. In: Sabiston DC, Lyerly HK eds. Textbook of Surgery.15th ed. Philadelphia: W.B. Saunders Company, 1997: 296–339.
Battistella FD, Benfield JR. Blunt an penetrating injuries of the chest wall, pleura and lungs. In: Shields TW, LoCicero J, Ponn RB eds. General thoracic surgery. 5th ed. Vol 1. Philadelphia: Lippincott Williams & Wilkins, 2000: 815–32.
LoCicero J, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am 1989; 69: 5.
Swan KG, Swan BC, Swan KG. Decelerational thoracic injury. J Trauma 2001; 51: 970–4.
Campbell DB. Trauma to the chest wall, lung and major airways. Semin Thorac Cardiovasc Surg 1992; 4: 243–7.
Collins J. Chest wall trauma. J Thorac Imaging 2000; 15: 112–9.
Sivaloganathan M, Stephens R, Grocott M. Management of flail chest. Hosp Med 2000; 61: 811.
Glinz W. Causes of early death in thoracic trauma. In: Webb WR, Besson A eds. Thoracic Surgery. Surgical Manegment of Chest Injuries. Vol 7. Louis: Mosby – Year Book, 1991.
Pickard LR, Mattox KL. Thoracic trauma and indications for thoracotomy. In: Mattox KL, Moore EE, Feliciano DV eds. Trauma. Norwalk: Appelton and Lange, 1988: 315–20.
Albaugh G, Kann B, Puc MM, Vemulapalli P, Marra S, Ross S. Age-adjusted outcomes in traumatic flail chest injures in the eldery. Am Surg 2000; 66: 978–81.
Pierson DJ. Indications for mechanical ventilation in adults with acute respiratory failure. Respir Care 2002; 47: 249–62.
Schacford SR, Virgilio R, Peters R. Selectiv use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg 1981; 81: 194–9.
Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 1988; 28: 298– 301.
Freedland M et al. The management of flail chest injury: factors affecting outcome. J Trauma 1990; 30: 1460–8.
Haasler GB. Open fixation of flail chest after blunt trauma. Ann Thorac Surg 1990; 49: 993–5.
Landreneau RJ, Hinson JM, Hazelrigg SR. Strut fixation of an extensive flail chest. Ann Thorac Surg 1991; 51: 473–5.
Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and vetilation. J Thorac Cardiovasc Surg 1995; 110: 1676–80.
Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma 1984; 24: 410–4.
Mouton W, Lardinois D, Furrer M, Regli B, Ris HB. Long-term follow up of patients with operative stabilisation of flail chest. Thorac Cardiovasc Surg 1997; 45: 242–4.
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