• Journal of Chest Surgery
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• 제33권10호
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• pp.806-811
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• 2000

Background : The authors have modified the method of Ravitch technique. Material and Method ; This technique was applied to 6 patients out of 18 patients who underwent corrective surgery from May 1987 to July 1999. The technique is quite different from that of Ravitch. We did not divide the intercostal muscle bundles from the laterals of sternum and the Akin's struts were placed retrosternally crossing the chest horizontally to prevent flail motion during immediate post-operative period and retraction of the sternum afterwards. Anterior sternal osteotomy instead of the posterior one was performed for the latest 3 cases which made operative procedure more simple and easy. The struts were removed one year later. Result : Compared to the hospital stay of the patients who received standard Ravitch method that of the six cases who received our modification was definitely shortened from 13.1 days to 8.3 days(p<0.0000). Flail motion was not noted in any patient and chest wall stability was obtained more easily with this technique. Conclusion : Our modification is recommendable for correction of funnel chest in regards to shorter operation time better chest wall stability shorter hospital stay and less complication.

• Journal of Chest Surgery
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• 제30권8호
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• pp.803-808
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• 1997

저자들은 1989년 8월부터 1995년 8월까지 흉부외상으로 인한 다발성 늑골골절 및 유동흉이 발생한 105례의 환자에게 Judet's strut를 이용한 늑골고정술로 치험하였다. 전체 환자중 86명이 남성, 19명이 여성이었으며 연령분포는 17세부터 77세로 평균연령은 $48\pm12였다.$ 흉부외상의 원인은 교통사고가 85명(81%)으로 가장 많았다. 평균 늑골골절의 수는 5.5개였으며 환자는 유동흉환자가 72명(64%), 이탈이 심한 다발성 늑골골절이 18명(17.1%), 외상성 흉벽기형이 10명(9.5%), 기타 5명(4.7%) 등이었다. 수술 후 1명이 사망하여 사망율 0.96%를 보였고 총 13명의 환자에서 합병증이 발생하여 12.3%의 발생율을 보였다. 수술후 인공호흡기 치료기간은 평균 $90.5\pm22.6시간,$ 동맥혈 검사상 PO2는 수술전 평균 $62.8\pm9.mmHg에서$ 수술후 평균 $113.0\pm26.3mmHg로$ 개선되었다. 수술 결과 인공호흡기 치료기간 및 입원기간의 단축, 흉부손상에 의한 합병증의 감소등 기존의 치료 방법에 비해 우수함을 알 수 있었다. 또한 본 술식은 누구나 시행할 수 있으며, 향후 흉부손상에 의한 다발성 늑골골절 및 유동흉 환자에서 폐좌상의 정도가 전체 용적의 30% 미만의 경우 치료 \ulcorner일차적으로 고려되어질 수 있는 치료법으로 여겨진다.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 추계학술대회
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• pp.227-227
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• 2009

• Journal of Trauma and Injury
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• 제34권4호
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• pp.284-287
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• 2021

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-yearold female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and "on the way out" SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

• Journal of Chest Surgery
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• 제50권4호
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• pp.229-234
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• 2017

Rib fractures are a common injury resulting from blunt chest trauma. The most important complications associated with rib fractures include death, pneumonia, and the need for mechanical ventilation. The development of new osteosynthesis materials has stimulated increased interest in the surgical treatment of rib fractures. Surgical stabilisation, however, is not needed for every patient with rib fractures or for every patient with flail chest. This paper presents an easy-to-use evidence-based algorithm, developed by the authors, for the treatment of patients with flail chest and isolated rib fractures.

• 한국임상수의학회지
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• 제33권2호
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• pp.124-128
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• 2016

A 7-year-old intact female Maltese dog presented with a history of bite wounds. Physical examination revealed labored breathing, four puncture wounds with subcutaneous emphysema of the thorax, and paradoxical respiratory movement of the right thoracic wall. On radiography, a segmental fracture of the right 7th rib and a single fracture of the 8th rib were evident on the dorsal thorax. An inward displacement of the fractured segment and contusion of the right caudal lung lobe were identified with computed tomography. A diagnosis of pseudo-flail chest was made. Exploratory thoracotomy revealed a full-thickness muscular defect, a marked discoloration of the right caudal lung lobe, a segmental fracture of the right 7th rib, and a single fracture of the right 8th rib. Necrotic tissues were removed using surgical debridement. The fractured 7th and 8th ribs were corrected using a single interfragmentary wiring technique. The thoracic wall was reconstructed using the latissimus dorsi muscle flap. Additional thoracic stabilization using a thermoplastic splint was applied to correct paradoxical respiratory movement. The external splint was removed 4 weeks postoperatively. There was no evidence of respiratory abnormalities 18 months postoperatively.

• Journal of Chest Surgery
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• 제12권4호
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• pp.411-417
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• 1979

During the period of 4 years from August 1, 1975 to August 1, 1979, authors have experienced 100 cases of multiple rib fractures by nonpenetrating injury at Department of Thoracic Surgery, Paik Foundation Hospital in Seoul, Korea. 1. The ratio of male to female patients with multiple rib fracture was 2.6:1 with male predominance and 84% of the total cases were between 20 and 50 years of age. 2. The most common cause of multiple rib fracture was traffic accident and falls accounted for the next largest group. 3. The most common site of rib fracture was 4th rib to 7th rib level on both hemithorax [52%]. 4. Associated injuries were cerebral contusion in 26%, clavicular fracture in 22%, long bone fracture in 22%, pelvic bone fracture in 10%, and scapular fracture in 8%. 5. Early complications and/or result of the multiple rib fractures were lung contusion in 23 cases, subcutaneous emphysema in 21 cases, hemothorax in 21 cases, hemopneumothorax in 6 cases, and flail chest in 12 cases. 6. The flail chests were managed by strapping the chest with adhesive plaster, external traction of flail segment with towel clip, ventilatory assistance for marginal clinical indications, and in cases of complicated with intrathoracic hemorrhage, wire fixation of flail segment through open thoraco-tomy. 7. The principles of therapy for hemothorax and/or pneumothorax were rapid reexpansion of the lungs by thoracentesis [11%] and closed thoracostomy [22%], but open thoracotomy had to be done on 3 cases because of massive bleeding or intrapleural hematoma and diaphragmatic rupture. 8. The over all mortality was 4% [4 among 100 cases] and the cause of all deaths was head injury.

• 대한흉부심장혈관외과학회:학술대회논문집
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• 대한흉부외과학회 1995년도 제27차년차학술대회 및 총회
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• pp.102-102
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• 1995

• Journal of Chest Surgery
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• 제28권2호
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• pp.218-220
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• 1995

This 51 years old male patient was admitted to the department of thoracic and cardiovascular surgery via OPD because of anterior chest pain. 7days before admission, He got the chest trauma after traffic accidents,the lateral chest roentgenogram showed complete transverse sternal fracture. He also complained of mild dyspnea. We also noticed that he had depressed anterior chest wall. It looks like funnel chest. The operative findings revealed dislocated & callus formations at the both 4th and 5th costochondral junction and transverse fracture of sternal body between 4th and 5th costochondral junction, the upper end of sternal fracture was situated below the lower end of sternal fracture. The two ends of sternal fracture were situated at the same level and reapproximated the two ends by two-interrupted wire sutures. The patient is well on the road to recovery after the operation.

• Journal of Chest Surgery
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• 제26권1호
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• pp.59-63
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• 1993

A clinical evaluation was performed with a population of 49 patients of chest trauma, who were diagnosed to undergo ventilator therapy, and had gone through ventilator therapy at the Department of Thoracic and Cardiovascular Surgery, Kyungpook University Hospital. One of most common causes of chest trauma was vehicle accidents [77.5%] with the prevalent age group being their forties. The common findings were multiple rib fractures [89.8%], hemopneumothrax [81.6%], lung contusion [61.2%] and flail chest [44.9%]. Their common combined injuries were the orthopedics and neurosugical injuries [86.7%]. Complications caused by chest trauma were pneumonia, respiratory failure, atelectasis, barotrauma and empyema. Pulmonary infections were commonly associated with mechanical ventilation in the long term group and were best prevented by using bronchial hygiene therapy.The mortality rate was 5.8% of the total patients and that was 38.8% of the patients, who needed ventilator therapy. The causes of death were pneumonia, respiratory failure, acute renal failure and hypovolemic shock. Mechanical ventilation has an important place in the treatment of patients with severe chest trauma.