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TUMORI DELLA PARETE TORACICA. CLASSIFICAZIONE, METODOLOGIA DIAGNOSTICA E PRINCIPI GENERALI SULLA TERAPIA.
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Crossed Kirschner's wires for the treatment of anterior flail chest: an extracortical rib fixation
Full text linkObjective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest
injury with high mortality rates. Surgery is not frequently performed and, in Literature, data
are controversial. The authors report their experience in the treatment of flail chest by an
extracortical internal-external stabilization technique with Kirshner's wires (K-wires).
Methods: From 2010 to 2015, 137 trauma patients (109 males and 28 females) with an
average age of 58.89+19.74 years were observed. Seventeen (12.4'lo/o) patients presented a
flail chest and of these, 13 (9.497o) with an anterior one. All flail chest patients underwent early
chest wall surgical stabilization (within 48 hours from the injury).
Results: ln the general population, an overall morbidity of 21.9o/o (n=30 of 137) and a
30-day mortality rate of 5."1%o (n=7 of 137) were observed. By clustering the population
according to the treatment (medical or interventional vs surgical), significant statistically
differences between the two cohorts were found in morbidity (12.650/ovs.34.48o/o, P=0.002)
and mortality rates (1.28olo vs."10.34o/o, P=0.017).ln patients undergoing chest wall surgical
stabilization, with an average lnjury Severity Score of 28.3 + 5.2 and Abbreviated lnjury Score
(AlS) of 8.4 + 1.7, an overall morbidity rate of 52.9o/o (n = 9) and a mortality rate of 17.60lo (n = 3)
were found. Post-surgical device removal, in local anesthesia or mild sedation. was performed
42.8+2.9 days after chest wall stabilization and no cases of wound infection, dislodgment
of the wires or osteosynthesis failure were reported. Moreover, in these patients, an early
postoperative improvement in pulmonary ventilation (ApaO, and ApCOr: +9.49 and -5.05,
respectively) was reported.
Conclusion: Surgical indication for the treatment of flail chest remains controversial and
debated both due to an inadequate training and the absence of comparative prospective
studies between various strategies. Our technique for the surgical treatment of the anterior
flail chest seems to be anachronistic, but the aspects described, both in terms of technical
features and of outcome and benefits (health, economic), allow to evaluate the effectiveness
of this approac
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