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    Traumatismo Toracico Epub Download

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    Reconstruction in the case of chest tumours was always accompanied by a flexible prosthesis to protect the intrathoracic content from the titanium connecting bar system 4 polyester prosthesis covered with resorbable collagen and 3 Gore-tex prostheses , depending on the size of the overall defect. Muscle flap closure was used for the defects in 5 cases latissimus dorsi flaps and in 1 case chest flap , with the exception of one case of primary closure. In one of the sternal resection cases with previous radiotherapy Fig. Only in the case of one patient with upper thoracic wall leiomyosarcoma was en bloc resection combined with an atypical resection of the upper right pulmonary lobe due to tumour infiltration. A Chest CT where sternal metastasis may be observed. C Greater omentum covering the defect below and above the bars. One bar was used in one patient, 2 in 3 patients and 3 in 3 patients. Chest drainage insertion was used for the soft tissues between the bars and the muscle flap. Choice of type and number of bars was always made in the operating theatre following surgical extraction, after taking the measurements of the defect and discovering the position of the rib tips and their spatial orientation, with an anatomical parallel or crossed over positioning 2 patients. Chest Wall Deformities and Defect Patients In this patient group of 4 patients, 3 had deformities from previous trauma and presented with pulmonary hernia Fig. Indications were to prevent recurrence in all cases, prevent collapse of the sternum in the pectus excavatum and restore normal anatomy. In the 3 pulmonary hernia cases a flexible prosthesis was inserted Gore-tex in all cases. A Detail of the diaphragmatic resection supported by Gore-tex prosthesis. Indication in all cases was the impossibility of mechanical ventilation extubation over 7 days of mechanical ventilation. None of the 3 patients had intrathoracic lesions which required emergency surgery.

    Saad Jr R, Rasslan S. CiteScore measures average citations received per document published. Bronchoscopy is the diagnostic method of choice and must be performed early.

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    Recommended articles Citing articles 0. Survival following non-penetrating traumatic rupture of the cardiac chambers.

    Author links open overlay panel F. J Clin Forensic Med. Si continua navegando, consideramos que acepta su uso.

    Diagnosis is based on clinical signs, imaging and bronchoscopy.

    The injury scale — a valuable tool for forensic documentation of trauma. Other types of articles such as reviews, editorials, special articles, clinical reports, and letters to the Editor are also published in the Journal.

    Manuscripts will be submitted electronically using the traumatjsmo web site: Continuing navigation will be considered as acceptance of this use. Rev Col Bras Cir. La paciente presentada fue dada de alta del hospital sin secuelas.

    The patient was released from care and has suffered no subsequent complications. Services on Demand Journal. In cases where there was double fracture a clip was attached to each rib fragment Fig. Open pleura chest drainage and subcutaneous drainage for prevention of postoperative seroma were performed in all 3 cases. ResultsPatients With Chest Wall Tumours Anatomopathological results were heterogeneous in the 7 patients 5 women and 2 men : 5 cases of primary chest wall tumours 1 chondrosarcoma, 1 malignant Schwannoma in the context of neurofibromatosis Fig.

    In all cases complete en bloc resections with tumour free borders were achieved, from disorders confirmed by anatomopathological analysis. All patients were extubated at the end of surgery with no complications. Average postoperative hospital stay was 6.

    Only 2 complications were recorded Table 1 : partial flap necrosis patient with leiomyosarcoma where single use negative pressure wound therapy system [PICO] was performed and primary closure was performed 20 days after the initial surgery; and a paroxysmal atrial fibrillation which was treated pharmacologically. A Preoperative thoracic MRI where an extensive lesion is observed. C Radiography of thorax for postoperative control.

    Observe how in this case we inserted 2 of the bars in a crossed-over position. Thirty days after surgery none of the patients needed pharmacological analgesia because of pain related to surgery.

    In all cases oncological follow-up continued for over a year.

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    One leiomyosarcoma patient presented a single contralateral lung metastasis treated with atypical resection by videothorascopy 10 months after the initial surgery. One patient with sternal metastasis after breast cancer presented cerebral metastasis 5 months after surgery which required oncological treatment. Twelve months after the above mentioned chest wall surgery, the patient with rib metastasis from cancer of the kidney was diagnosed with lumbar and sternal bone metastasis.

    None of the patients presented local recurrence of their disease. Average hospital stay was 4 days 3—6 days.

    At 30 days no postoperative complications had been recorded. None of the patients took analgesics one month after surgery. Both functional and cosmetic results were satisfactory.

    Follow-up was at least 12 months 12—19 months in the 3 patients with no evidence of recurrence. Patients With Severe Rib Injury The 3 patients were men with an average age of 56 years range: 45— All cases were due to traffic accidents. Mean rib fractures were 9 rib arches 7—12 rib arches.

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    None presented brain injury, verified by CT scan. There were no intrathoracic injuries which required emergency surgery. One patient presented an open tibia fracture which required surgery on admittance and another had needed a chest drain which had already been positioned for pneumothorax. Two patients were admitted to hospital with intubation one was the patient with the tibia fracture and the third patient was intubated 6h after admittance suffering from respiratory failure.

    Extubation was attempted in all 3 patients without success. They received mechanical ventilation for at least 7 days. All patients were extubated 24h after surgery and left the ICU in less than 48h. No intraoperative complications were recorded. One patient presented an ipsilateral pneumonia in the hemithorax on which surgery had been performed.

    The patient responded to antibiotherapy. No other postoperative complications were recorded.

    Overall average stay was 18 days 15—23 days. The patients were monitored at 1 month and 3 months following discharge, with satisfactory radiological and clinical condition.

    Discussion Extended wall resections, chest deformities and multiple rib fractures leading to chest wall failure present a challenge to the surgeon.

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