Surgical tactics for chest trauma accombined by flail chest

Abstract

Thoracic trauma, often characterised as closed, comprises 23% to 56.9% of polytrauma cases.According to our research, flail chest in thoracic trauma occurs in approximately 7.9—8.9% of cases. The primary factors contributing to this instability are car accidents or falls from a height.

Objective — to enhance the outcomes of surgical treatment for patients with flail chest by applying novel techniques for assessing the severity of injuries and implementing improved surgical tactics.

Materials and methods. The study included a total sample of 123 patients who had flail chest. The participants were divided into 2 groups: the control group (n=56) and the comparison group (n=67). The ATS scale was used to assess the severity of the condition in the groups. The injury severity score was determined using a point‑based system and categorised as minor, severe, or extremely severe. The control group was additionally evaluated using the AdTS scale, while the perfusion index was measured.

Results. The injury severity score determined using the AdTS scale and the perfusion index formed the basis of an algorithm for differential diagnosis that influenced the indication area and scope of diagnostic procedures. The choice of surgical tactics was based on the results of an additional examination and the injury severity score. For a minor injury, the full range of medical procedures was carried out. For a severe injury, a shortened list of procedures was prescribed. In the case of an extremely severe injury, care was provided using the principles of DCS technology. The chest stabilisation procedure was conducted using the suggested approach for assessing the severity of the injury: less traumatic operations were performed for severe injuries, while full‑scale operations were carried out for minor injuries. The selection of the method for stabilising floating segments was based on the established classification of chest instability. The stabilisation of flail chest was carried out either during the first or third phase of the DCS technology or after the patient had been brought out of a state of shock, in accordance with delayed indications.

Conclusions. The application of the AdTS anatomical and functional scale and the determination of the perfusion index allowed for a rapid and objective evaluation of the injury severity score (minor, severe, and extremely severe). Additionally, these tools helped in identifying the appropriate diagnostic procedures and deciding on the method for stabilising the flail chest. The differential diagnostic programme implemented in the control group made it possible to reduce the examination time for patients with an extremely severe injury by 9.8±1.1 minutes. Implementing the proposed injury severity assessment and stabilisation tactics decreased the number of late purulent‑septic complications by 19.8% and mortality by 17.4% (from 38.8% to 21.4%).