Pulmonary contusion is frequent and a serious injury in the chest trauma patients in emergency department. And it is easy to induce acute respiratory distress syndrome (ARDS) and respiratory failure. Since the development of modern technology and transportation, flail chest with pulmonary contusion happens more frequently than the past. And its complications and mortality are higher. In order to understand it better and improve the effect of the therapy on flail chest with pulmonary contusion, we reviewed the relative literatures. In this article, the main contents are as followed:① The pathophysiological changes of pulmonary contusion; ② The pathophysiological changes of flail chest with pulmonary contusion; ③ Clinical manifestation of flail chest with pulmonary contusion; ④ Imaging change of flail chest with pulmonary contusion; ⑤ progress in diagnosis and treatment.
Objective To investigate the changed rules of the cardiac functions in rabbits and to provide theoretical gists for clinical diagnosis and treatment after blunt chest trauma(BCT). Methods Using the models of moderate to severe BCT with BIM-Ⅱ Bio-impactor in 20 rabbits to examinate the cardiac functions with cardiac catheterization, the single photonemission computed tomography(SPECT) and the Doppler echocardiography at preinjury and 1h, 2h, 4h, 6h, 8h, 12h and 24h after BCT. Results Central venous pressure( CVP）, left ventricular enddiastolic pressure (LVEDP) and the decreasing time constant of left intraventricular pressure (T) at 24h after trauma were higher obviously than those before trauma (Plt;0.05,0.01). The -dp/dtmax at 24h after trauma was lower markedly than that before trauma (Plt;0.05 ). The ejection fraction(EF),1/3 EF, 1/3 ejection rate（1/3ER） and the ratio of 1/3 filling rate (1/3FR) to 1/3ER of the right ventricle at 24h after impacted were lower markedly than those before impacted (Plt;0.05). The peak filling rate, 1/3 filling fraction, 1/3 filling rate, the ratio of peak filling rate to peak ejection rate and the ratio of 1/3FR to 1/3ER of the left ventricular at 24h after impacted were lower obviously than those before impacted (Plt;0.05, 0.01). Conclusion The cardiac functions are changed significantly after BCT. The expressions of the right ventricular dysfunctions mainly are systolic dysfunction while the left ventricular dysfunctions are mainly diastolic dysfunction after BCT. All the cardiac catheterization, SPECT and the Doppler echocardiography are beneficial to the diagnosis of cardiac dysfunction after BCT. The SPECT is more exactitude and the Doppler echocardiography is more cheaper.
ObjectiveTo investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.MethodThe clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.ResultsThe time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).ConclusionIn strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.
ObjectiveTo explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease.MethodsA retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity.ResultsAll patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis.ConclusionAlthough the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.
On account of the mechanical disturbance of external chest pressing to electrocardiogram (ECG) signal, the ECG rhythm cannot be identified reliably during the cardio-pulmonary resuscitation period. Whereas the possibility of successful resuscitation will be lowered due to interrupted external chest pressing, a new filtering algorithm, enhanced leastmean-square (eLMS) algorithm, was proposed and developed in our laboratory. The algorithm can filter the disturbance of external chest pressing without the support of hardware reference signal and correctly identify ventricular fibrillation (VF) rhythm and normal sinus rhythm in case of uninterrupted external chest pressing. Without other reference signals, this algorithm realizes filtering only through the interrupted electrocardiograma (cECG) signal. It was verified with ECG signal and disturbance signal under different signal to noise ratios and contrasted with other mature algorithms. The verification results showed that the identification effect of eLMS was superior to those of others under different signal to noise ratios. Furthermore, ECG rhythm can be correctly identified only through cECG signal. This algorithm not only reduces the research and development(R & D)costs of automated external defibrillator but also raises the identification accuracy of ECG rhythm and the possibility of successful resuscitation.
Objective
To explore the feasibility of establishing a rabbit model of flail chest.
Methods
Flail chest model was eatablished in 12 New Zealand white rabbits after anesthesia and sterile surgery. The paradoxical movement of chest wall was recorded by the biological signal acquisition system, arterial blood was collected for blood gas analysis, the vital signs were recorded by electrocardiogram (ECG) and the lung tissue was taken for the pathological analysis at the end of the experiment. The effect of flail chest on the respiratory function of experimental animals was analyzed to evaluate the feasibility of establishing flail chest model.
Results
All surgeries were successful without mortality. The operation time was 41.42±7.08 min. Duration of endotracheal intubation was 79.33±12.21 min. Statistical results showed that the pH, partial pressure of arterial carbon dioxide (PaCO2) and base excess (BE) increased; while partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) reduced. Pathological results showed that flail chest not intervented for a long period would lead to organic lesions.
Conclusion
The rabbit model of flail chest is feasible, safe, repeatable, easy and simple to handle. The animal is easy to access which is the foundation to study the disease process, recovery procedure and the efficacy after intervention.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
Objective To evaluate the efficacy and safety of intraoperative pleural irrigation with nocardia rubra cell-wall skeleton (N-CWS) for reducing pleural effusion drainage after radical surgery for lung cancer. Methods A retrospective analysis was conducted on the clinical data of lung cancer patients who underwent lobectomy and mediastinal lymph node dissection at the First Affiliated Hospital of Xiamen University between December 2024 and May 2025. Patients were divided into a control group and an irrigation group based on the intraoperative use of N-CWS. Patients in the irrigation group received pleural irrigation with 800 μg of N-CWS diluted in 10 mL of normal saline. The following outcomes were compared between the two groups: pleural effusion drainage volume at 0-24 h, 24-48 h, and 48-72 h postoperatively; degree of air leak; chest tube duration; postoperative length of stay; and the incidence of adverse events (fever, chest pain, and vomiting). Results A total of 245 patients were included (97 males, 148 females) with a mean age of (61.28±6.26) years, with 205 in the control group and 40 in the irrigation group. Compared to the control group, the irrigation group showed significantly lower pleural effusion drainage volumes at 0-24 h, 24-48 h, and 48-72 h, as well as shorter chest tube duration and postoperative length of stay (all P<0.05). There was no significant difference in the degree of postoperative air leak (P=0.801). No significant differences were observed between the two groups regarding the highest body temperature within 72 h post-surgery (P=0.130), fever grade (P=0.450), severity of chest pain (P=0.138), or the incidence of nausea and vomiting (P=0.376). ConclusionIntraoperative pleural irrigation with N-CWS in patients undergoing lobectomy and mediastinal lymph node dissection for lung cancer can significantly reduce postoperative pleural effusion drainage volume, shorten chest tube duration, and decrease the length of hospital stay. The procedure is safe and feasible.
ObjectiveTo investigate the application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect. Methods Between August 2018 and December 2020, 12 patients, including 4 males and 8 females, were treated with expanded anterolateral thigh myocutaneous flap to repair huge complex defects after thoracic wall tumor surgery. The age ranged from 28 to 72 years, with an average of 54.9 years. There were 4 cases of phyllodes cell sarcoma, 2 cases of soft tissue sarcoma, 1 case of metastatic chest wall tumor of lung cancer, and 5 cases of breast cancer recurrence. All cases underwent 2-7 tumor resection operations, of which 3 cases had previously received lower abdominal flap transplantation and total flap failure occurred, the other 9 cases were thin and were not suitable to use the abdomen as the flap donor site. After thorough debridement, the area of secondary chest wall defect was 300-600 cm2; the length of the flap was (24.7±0.7) cm, the width of the skin island was (10.6±0.7) cm, the length of the lateral femoral muscular flap was (26.8±0.5) cm, the width was (15.3±0.6) cm, and the length of the vascular pedicle was (7.9±0.6) cm. Results The myocutaneous flaps and the skin grafts on the muscular flaps were all survived in 11 patients, and the wounds in the donor and recipient sites healed by first intention. One male patient had a dehiscence of the chest wall incision, which was further repaired by omentum combined with skin graft. The appearance of the reconstructed chest wall in 12 patients was good, the texture was satisfactory, and there was no skin flap contracture and deformation. Only linear scar was left in the donor site of the flap, and slight hyperplastic scar was left in the skin harvesting site, which had no significant effect on the function of the thigh. All patients were followed up 9-15 months, with an average of 12.6 months. No tumor recurrence was found. ConclusionThe expanded anterolateral thigh myocutaneous flap surgery is easy to operate, the effective repair area is significantly increased, and multiple flap transplantation is avoided. It can be used as a rescue means for the repair of huge chest wall defects.
