PubMed · 7385173
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C F Tidemann. 1980-02-29. [Wounds].. https://pubmed.ncbi.nlm.nih.gov/7385173/
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BACKGROUND: Reconstruction of complex chest wall defects represents a major challenge and requires close cooperation between the cardiothoracic and reconstructive surgeon to achieve an optimal outcome and reduce the incidence of complications. The principles of chest wall reconstruction include control of infection, local wound care, wide debridement of all necrotic and devitalized tissues, obliteration of all residual cavities and spaces with well-vascularized tissues, reestablishment, when necessary, of the continuity and skeletal stability of the chest wall, and immediate or early definitive coverage of all defects with well-vascularized tissues. METHODS: This paper is based on our experience with 113 patients who underwent chest wall reconstruction for a variety of defects resulting from infection, trauma, tumor extirpation, and radionecrosis. All patients were treated with a variety of muscle flaps and/or omentum which provided obliteration of dead space and coverage. Seven patients with large anterolateral defects required additional skeletal stability with synthetic patches or mesh. RESULTS: 88.6% of patients healed without significant problems. 8.8% had major complications requiring reoperation and prolonged hospitalization while 4.4% had minor complications. CONCLUSIONS: Based on long-term experience, we believe that currently the use of well-vascularized tissue is the method of choice for reconstruction of complex chest wall defects. This provides stable coverage, reduces hospital stay, and thus lowers overall care cost for these patients.
As advancements are made in the prevention of automobile fatalities, an increase in the incidence of pelvic and lower extremity injuries has occurred. These remain the leading causes of impairment and loss of years of productive life. Pelvic trauma has a high initial mortality rate when severe. However, with early resuscitation and transport, more survivors arrive in our trauma centers harboring these injuries. Owing to early stabilization and mobilization of the traumatized patient, a decrease in complications in these patients has been noted. Both the trauma surgeon and the orthopedic trauma surgeon should work as a team and remain in continuous communication during the treatment of these patients. Open fractures are among the most difficult problems to manage; early and aggressive decisions can prevent a lifetime of complications and physical impairment. As previously stated, to obtain good outcomes, open fractures must be treated initially at the accident scene followed by timely transport to the trauma center for definitive care. It must be remembered that the golden time to prevent major complications is 6 hours. Intra-articular fractures of the lower extremity involve a major weight bearing joint. Post-traumatic arthritis and impairment develop in joints where joint congruity is not achieved. To preserve normal function, there should be articular congruity, stable fixation, axial alignment with the rest of the extremity, and restoration of full range of motion. Immediate stabilization of long bone fractures has many advantages in the multiply injured patient, such as improved long-term function, prevention of deep venous thrombosis and decubitus ulcer, decreased need for analgesia, and reduction in the incidence of adult respiratory distress syndrome and fat emboli. Patients with femoral shaft fractures should undergo immediate stabilization of the fracture within 24 hours of injury. We have presented a series of orthopedic injuries that have high mortality and high morbidity which, if not treated expediently, yield a high degree of impairment.
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