Figure 1 - uploaded by Mirko Barone
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Surgical technique for the stabilization of the anterior flail chest with crossed Kirschner's wires (subxiphoid access).
Source publication
Objective: 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 Kirshne...
Context in source publication
Context 1
... the patient in the supine position, the technique involves a crossed placement (i.e. "Saint Andrew's cross") of these devices via a minimally invasive subxiphoid access or via a bilateral video thoracoscopic one (Figure 1). In open surgery, a subxiphoid incision is performed in order to access into the anterior mediastinum and to proceed with a blind-fin- gered dissection between the endothoracic fascia and the parietal pleurae. ...
Similar publications
Objective: 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 Kirshne...
Citations
... Kirschner wires (k-wire) have been reported in multiple studies with generally good results [18,46]; however, authors reported rotational instability of the fractures due to the small cross section of the devices [47] and the potential for loss of fracture reduction with migration of the wire resulting in additional injury to the surrounding tissue [48,49]. A particular extracortical fixation technique by means Kwires has been described [50]. The Authors, in a retrospective study involving seventeen flail chest patients, reported no cases of wound infection, dislodgment of the wires or osteosynthesis failure with an early postoperative improvement in pulmonary ventilation (Dpa O 2 and Dp CO 2 ). ...
Purpose of Review
Rib fractures are common among trauma patients with both blunt chest wall and thoraco-abdominal trauma, seen in up to 39% of patients following blunt chest trauma and present in 10% of all trauma admissions and, in these individuals, mortality rates can reach 9–16%. Notwithstanding, the objective of surgical stabilization is to recover thoracic wall rigidity and restore normal ventilation and functions, thus decreasing mortality and morbidity.
Recent Findings
Currently, all possible indications for surgical rib fixation are far away from a consensus statement backed up with strong evidence.
Summary
The aim of this review article is to highlight both the usefulness and the pitfalls of operative rib fixation techniques.
