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Objective: Management of flail chest still remains subject of controversy. Fractured ribs, if treated only with mechanical ventilation, can undergo progressive displacement and the patient can suffer from chest wall deformity, atelectasis and volume restriction. If sternum is also affected resulting in severe antero lateral fail chest,conservative management may not be sufficient. We used Nuss technique´s to achieve chest wall stabilization once weaning from the ventilator was not possible.
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Jose R. Matilla, Francisco Felix, Teresa Magalhaes Godinho.
Thoracic Surgery, Pulido Valente Hospital, Lisbon, Portugal.
We report a 49 years old patient who suffered a car accident.As result of the blunt chest trauma he presented bilateral lung contusion,bilateral haemo/pneumothorax, sternum fracture, four ribs fractures on the right hemithorax, six ribs fractures on the left hemithorax and tricuspid valve rupture.No other mayor injuries were observed.After bilateral pleural drainage patient was intubated and ventilated: pressure control ventilation the first day and pressure support ventilation until the 12th day without weaning success.
Methods: After exclusion of urgent tricuspid valve surgical indication, patient was ventilated until lung contusion was large minimized. He was operated on 12th ventilation day and adult steel bar inserted at the 5th intercostal space under thoracoscopic control.
Results:
Weaning was achieved in 36 hours and patient was discharged in 17 days.Pectus bar was removed three months later.
Conclusions: Usually surgical stabilization of severe fail chest due to unsuccess conservatory treatment requires large antero lateral incisions and use of multiple metal plates.Chest wall stabilization was achieved using minimal invasive pectus excavatum tecnique.Technique also allowed stetic benefits, weaning was possible in 36 hours after surgery, chest wall muscles were preserved and pain was minimized.
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