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International Society For Minimally Invasive Cardiothoracic Surgery

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Flail Chest Rigidity Management By External Vacuum-assisted Therapy
Cristian Paleru, MD1, Vlad Popescu, MD2, Laurentiu Marinescu, MD3.
1"Marius Nasta" Pneumoftiziology Institute Hospital, Bucharest, Romania, 2"Sf. Maria" Clinical Hospital, Bucharest, Romania, 3Bucharest Clinical Emergency Hospital, Bucharest, Romania.

BACKGROUND: We present the case of a patient with post-traumatic flail chest, after car crash, with mild contusions and associated trauma. Pneumatic stabilization was achieved with the use of noninvasive positive-pressure ventilation (NPPV) followed by intubation, with the risk of ventilation-related pathology. Patient presented respiratory distress with SpO2 value of 85%, pCO2 and pO2 values showed mild hypercapnia and EKG showed normal sinus rhythm, with no respiratory nor cardiovascular history.
METHODS: The post-traumatic flail-chest presented with C4,C5,C6 double rib fractures on a 7 cm segment in the imaging findings with no significant associated trauma. Therapy addressed 4 steps: analgesia, intubation and ventilation, chest tube insertion and rib fracture fixation. External fixation and stabilization with metal plates is common for large chest wall injuries. Diagnosis was established between clinical and imaging findings to be post-traumatic flail chest.
RESULTS: Following vacuum-assisted therapy in sternal wound dehiscence management and in external fixation of postoperative extensive thoracotomy wound with multiple rib resection, we imagined an external application of the vacuum-assisted therapy. The technique consists of applying pieces of open-cell foam externally, secured with plastic bands and covering the entire area with a transparent adhesive membrane, which is firmly secured to the skin and connected to the vacuum source. The therapy showed improvement in thoracic wall compliance and movement.
CONCLUSIONS: Our initial experience in external fixation showed improvement of the paradoxical chest movement. Following vacuum-assisted therapy in sternal wound dehiscence management, our limited experience in external fixation of extensive thoracotomies and vast experience in chest wall resection and reconstruction, we imagined an easy-to-control external application of the vacuum- assisted therapy. It is a versatile system, simple to apply to a cheap device, can also be used in emergencies, without direct medical supervision, during transportation, avoiding further costal movements.

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