Abstract：Objective To investigate clinical effect of damage control surgery （DCS） in treatment of patients with flail chest combined with severe multiple injuries. Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments: DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib. Complications, mortality, and main parameters before and after operation in each group were analyzed and compared. Results Complications including pulmonary infection (32 cases), atelectasis (38 cases), and acute lung injury (ALI)/ARDS (39 cases) were found. Twenty-two cases died, including 13 deaths from ARDS, two from tension pneumothorax, one from massive hemoptysis, three from cardiac shock, two from craniocerebral injury, and one from liver trauma and thus the overall death rate occupied 11.8%. Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P＜0.01), but the change of OI was inappreciable in Group B. Mortality, complication rate, cases treated with mechanical ventilation, tracheotomy or fiberoptic bronchoscopy, and average length of ICU and hospital stay were the lowest in the DCS Group, followed by a relatively higher result in Group B and a much higher result in Group A (P＜0.01). Conclusion DCS decreases mortality and complications dramatically when applied to treat flail chest combined with severe multiple trauma.
GAO Jin-mou,DU Ding-yuan,LIU Chao-pu et al. Damage control surgery for treatment of flail chest combined with multiple trauma[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(4): 343-347.
［8］Mayberry JC, Ham LB, Schipper PH, et al. Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair. J Trauma, 2009, 66(3):875-879.
［9］Mayberry JC, Kroeker AD, Ham LB, et al. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg, 2009, 75(5):389-394.
［10］Bottlang M, Helzel I, Long WB, et al. Anatomically contoured plates for fixation of rib fractures. J Trauma, 2010, 68(3):611-615.
［11］Marasco S, Cooper J, Pick A, et al. Pilot study of operative fixation of fractured ribs in patients with flail chest. ANZ J Surg, 2009, 79(11):804-808.
［12］Pettiford BL, Luketich JD, Landreneau RJ. The management of flail chest. Thorac Surg Clin, 2007, 17(1):25-33.
［13］Richardson JD, Franklin GA, Heffley S, et al. Operative fixation of chest wall fractures: an underused procedure? Am Surg, 2007, 73(6):591-596.
［14］Jounoo SS, Harji DP. Damage control surgery. Int J Surg, 2009, 7(2):110-113.
［15］Rotondo MF, Bard MR. Damage control surgery for thoracic injuries. Injury, 2004, 35(7):649-654.
［16］高劲谋. 损伤控制外科的进展. 中华创伤杂志, 2006, 22(5):324-326.
［17］Athanassiadi K, Theakos N, Kalantzi N, et al. Prognostic factors in flail-chest patients. Eur J Cardiothorac Surg, 2010, 38(4):466-471.
［18］Donath J, Miller A. Restrictive chest wall disorders. Semin Respir Crit Care Med, 2009, 30(3):275-292.
