Current status and research progress of minimally invasive
surgery for flail chest (Review)

Xia,Honggang; Zhu,Deqing; Li,Jing; Sun,Zhongyi; Deng,Limin; Zhu,Pengzhi; Zhang,Yongmin; Li,Xuan; Wang,Dongbin

doi:10.3892/etm.2019.8264

January-2020 Volume 19 Issue 1

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January-2020 Volume 19 Issue 1

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Review Open Access

Current status and research progress of minimally invasive surgery for flail chest (Review)

Authors:
- Honggang Xia
- Deqing Zhu
- Jing Li
- Zhongyi Sun
- Limin Deng
- Pengzhi Zhu
- Yongmin Zhang
- Xuan Li
- Dongbin Wang
View Affiliations / Copyright

Affiliations: Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China, Teaching and Research Division, Tianjin Medical College, Tianjin 300000, P.R. China

Copyright: © Xia et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 421-427
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Published online on: December 2, 2019

https://doi.org/10.3892/etm.2019.8264
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Abstract

Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20‑25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost‑effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video‑assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.

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