PURPOSE: We have adopted a multispecialty task force and developed a new classification for flail chest and standardization of minimally invasive repair of rib and sternal fractures (SMIRRFS) utilizing rib platting system in association with VATS (video assisted thoracoscopy surgery) as early as possible after a traumatic injury to avoid prolonged ventilation, VAP, tracheostomy and promote early mobilization of the patient.
METHODS: A prospective, case study of 5 patients with complex flail chest and associated injuries. There were 3 males and 2 females. Average age was 41. Two patients presented with lung herniations into the subcutaneous tissue. One patient had a brochopleural fistula from a traumatic intraparenchymal pneumatocele, requiring lobectomy and wedge resection and repair of the flail segments. Another patient required sternal and bilateral rib platting, and one required platting of higher ribs, behind the scapula.
RESULTS: LOS was 24 days. Average ventilator days was 14. Two patients required tracheostomy due to multiple operative interventions. One patient developed VAP. There were a total of 22 ribs platted and 1 sternal platting. VATS was used in 3 patients to define the level of fractures and to treat hemothorax and lung resections. There was no mortality in this group.
CONCLUSION: This study allowed us to develop a new classification for flail chest and thereby, helped us to standardize the repair of rib and sternal fractures. Our approach has been to repair flail segment(s) as soon as the patient's physiologic parameters stabilize. We utilize VATS as an adjunct to our procedure to determine the level of injury and to treat intrathoracic injuries, such as hemothorax and resection of nonviable lung segments.
CLINICAL IMPLICATIONS: A paradigm shift in treating complex chest wall and pulmonary injuries by developing a new classification, early intervention with SMIRRFS and adopting multispecialty task force. We propose early versus delayed repair in order to avoid prolonged ventilation, atelectasis, VAP, to promote early mobilization and pain control by returning the thoracic cage to its integrity.
DISCLOSURE: Marcelo DaSilva, None.