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Case Reports
. 2011 Winter;19(4):145-7.
doi: 10.1177/229255031101900408.

Management of pulmonary hernia through a flail segment in closed thoracic trauma using open reduction, internal fixation and pectoralis major flap reconstruction: A case report

Steven T Lanier  1 , Meredith Wetterau, Eduardo Smith-Singares, Thomas Bilfinger, James Vosswinkel, Marc J Shapiro, Alexander B Dagum
Affiliations
Case Reports

Management of pulmonary hernia through a flail segment in closed thoracic trauma using open reduction, internal fixation and pectoralis major flap reconstruction: A case report

Steven T Lanier et al. Can J Plast Surg. 2011 Winter.

Abstract
in English, French

The present article reports on the successful management of a large flail chest with traumatic pulmonary herniation in a patient who could not be weaned from mechanical ventilation following a course of conservative management. Surgical intervention involved open reduction and internal fixation with tubular plates to stabilize the flail segment, followed by a pectoralis major myocutaneous flap to repair the chest wall defect. Following surgical intervention, the patient was able to be weaned from mechanical ventilation and showed remarkable improvement in pulmonary function parameters. To the authors' knowledge, the present report is the first to describe the use of open reduction and internal fixation of the chest wall and flap reconstruction to treat lung herniation with a flail chest segment.

Le présent article rend compte de la prise en charge réussie d’une importante herniation traumatique du volet costal du poumon chez un patient qui ne pouvait être sevré d’une ventilation mécanique après la durée d’un traitement classique. L’intervention chirurgicale a inclus une réduction ouverte et une fixation interne à l’aide de plaques tubulaires en vue de stabiliser le segment costal, ainsi que d’un lambeau myocutané du grand pectoral pour réparer l’anomalie de la paroi thoracique. Après l’intervention chirurgicale, le patient a pu être sevré de la ventilation mécanique et a démontré une remarquable amélioration des paramètres de la fonction pulmonaire. En autant que le sache les auteurs, le présent rapport est le premier à décrire le recours à une réduction ouverte, à une fixation interne de la paroi thoracique et à une reconstruction par lambeau pour traiter une herniation pulmonaire au moyen d’un segment costal du thorax.

Keywords: Flail chest; Pectoralis major myocutaneous flap; Pulmonary herniation.

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Figures

Figure 1
Figure 1
Chest x-ray showing multiple rib fractures and disruption of the left sternocostal junction
Figure 2
Figure 2
Computed tomography showing pneumomediastinum, subcutaneous emphysema, and disruption of the chest wall with lung herniation
Figure 3
Figure 3
A Preoperative photograph. B Intraoperative photograph, before repair. C Intraoperative photograph, following repair of the flail segment
Figure 4
Figure 4
Chest x-ray following hardware removal showing healed fractures
See this image and copyright information in PMC

References

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