Reconstructive surgery for late complications after blunt chest wall trauma

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OBJECTIVE

To analyze the incidence and structure of late complications after blunt chest trauma, feasibility of surgical correction and effectiveness of these interventions.

MATERIAL AND METHODS

Treatment outcomes were analyzed in 26 patients with late complications of blunt chest wall trauma. Severe chest deformities were diagnosed in 8 patients, non-union rib fracture — 5, pulmonary hernia — 4, chronic abscesses and pseudocysts of soft tissues of the chest — 3, osteomyelitis of the ribs — 3, chronic recurrent pulmonary bleeding following damage to lung parenchyma by rib fragments — 2, persistent post-traumatic pleuritis — in 1 patient.

RESULTS

Among 26 patients, 23 ones underwent surgical correction of complications. Reconstructive procedures were performed in 5 out of 8 patients with post-traumatic chest deformities. In 5 patients with non-union rib fractures, surgery consisted of resection of ribs, excision of capsule and scar tissue, osteosynthesis. Thoracic pulmonary hernia required thoracotomy, viscerolysis, chest wall defect closure by bringing together the ribs and fixing with pulley sutures or ZipFix system. In 2 patients, pulmonary hernia was combined with non-union rib fracture. These patients underwent additional resection of false joints and osteosynthesis. Three patients were diagnosed with chronic abscesses and pseudocysts of soft tissues of the chest. Surgical treatment was carried out according to the principles of staged debridement of chronic purulent foci. Osteomyelitis of ribs in 3 patients required resection within intact tissues. Fixation of ribs by metal structures was not performed in these patients, and we performed only muscle and soft tissue repair. Conservative treatment was carried out in 3 patients with chest deformity. There were no lethal outcomes.

CONCLUSION

Pathological syndromes in long-term period after blunt chest trauma require surgical correction. Surgical treatment of patients with late complications of chest trauma should be aimed at chest stabilization, improving respiratory function and preventing secondary and tertiary complications. Osteosynthesis allows not only to eliminate pathological syndromes, but also increase tolerance to physical activity and quality of life.

Keywords:

blunt chest trauma

multiple rib fractures

late complications

rib osteosynthesis

Authors:

Benyan A.S.

Samara State Medical University

ORCID: 0000-0003-4371-7426

Korymasov E.A.

Samara State Medical University;
Seredavin Samara Regional Clinical Hospital

ORCID: 0000-0001-9732-5212

Medvedchikov-Ardiya M.A.

Samara State Medical University

ORCID: 0000-0002-8884-1677

Received:

16.01.2023

Accepted:

13.02.2023

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