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Review
. 2024 Mar;127(3):171-179.
doi: 10.1007/s00113-023-01400-2. Epub 2024 Jan 12.

[Surgical reconstruction of chest wall instability : Indications, contraindications and timing of surgery]

[Article in German]
Christopher Spering  1 , Onnen Moerer  2 , Thomas W White  3 , Wolfgang Lehmann  4
Affiliations
Review

[Surgical reconstruction of chest wall instability : Indications, contraindications and timing of surgery]

[Article in German]
Christopher Spering et al. Unfallchirurgie (Heidelb). 2024 Mar.

Abstract
in English, German

The impact of energy on the thorax can lead to serial rib fractures, sternal fractures, the combination of both and to injury of intrathoracic organs depending on the type, localization and intensity. Sometimes this results in chest wall instability with severe impairment of the respiratory mechanics. In the last decade the importance of surgical chest wall reconstruction in cases of chest wall instability has greatly increased. The evidence for a surgical approach has in the meantime been supported by prospective randomized multicenter studies, multiple retrospective data analyses and meta-analyses based on these studies, including a Cochrane review. The assessment of form and severity of the trauma and the degree of impairment of the respiratory mechanism are the basis for a structured decision on an extended conservative or surgical reconstructive strategy as well as the timing, type and extent of the operation. The morbidity (rate of pneumonia, duration of intensive care unit stay and mechanical ventilation) and fatality can be reduced by a timely surgery within 72 h after trauma. In this article the already established and evidence-based algorithms for surgical chest wall reconstruction are discussed in the context of the current evidence.

Eine auf den Thorax einwirkende Energie kann je nach Art, Lokalisation und Intensität zu Rippenserien- oder Sternumfrakturen, der Kombination aus beiden und zur Verletzung intrathorakaler Organe führen. Mitunter resultiert eine Instabilität der Thoraxwand mit hochgradiger Einschränkung der Atemmechanik. In der vergangenen Dekade hat die operative Thoraxwandrekonstruktion bei Thoraxwandinstabilität stark an Bedeutung gewonnen. Die Evidenz für ein operatives Vorgehen stützt sich mittlerweile auf prospektive randomisierte multizentrische Studien, multiple retrospektive Datenanalysen und darauf fußende Metaanalysen. einschließlich eines Cochrane-Reviews. Die Beurteilungen der Art und Schwere des einwirkenden Traumas sowie des Grads der atemmechanischen Einschränkung sind die Basis einer strukturierten Entscheidung über eine erweiterte konservative oder operativ-rekonstruktive Strategie sowie Operationszeitpunkt, -art und -umfang. Durch die frühzeitige Operation innerhalb von 72 h können Morbidität (Pneumonierate, Intensivstationsliege- und Beatmungsdauer) sowie Letalität verringert werden. Im vorliegenden Beitrag werden bereits etablierte und evidenzbasierte Algorithmen zur Thoraxwandrekonstruktion im Kontext der aktuellen Evidenz diskutiert.

Keywords: Breathing mechanics; Early therapy; Flail chest; Serial rib fracture; Trauma.

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References

Literatur

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