Vacuum assisted stabilization of flail chest – a comparative case control pilot study

Abstract

Flail chest is associated with high rates of morbidity and mortality and management of such condition is a multidisciplinary task that should be based on pain control, judicious fluid administration, adequate pulmonary hygiene and management of the paradoxical movements of the thoracic wall. Many methods of treating rib fractures and flail chest have been developed over the years. Our aim was to evaluate a novel method of flail chest stabilization using negative vacuum pressure and compare it to a traditional method. Material and methods: 10 patients with flail chest from trauma admitted in Thoracic Surgery Clinic from Clinical County Emergency Hospital of Craiova and County Emergency Hospital of Targoviste were submitted to stabilization using Vacuum Assisted Closure kit. This series of patients were compared with 10 patients in whom a traditional method of stabilization was used, selected from the database of patients from the Thoracic Surgery Clinic of Clinical Emergency Hospital of Craiova, used as control group. Results: The 2 groups were comparable as no statistically significant differences were found regarding the  gender, mean age, type of trauma, associated trauma, preexistent conditions, number of rib fractures, presence of pulmonary contusion, thoracic deformity. The parameters investigated: number of days with mechanical ventilation, number of days spent in ICU, total hospital stay, mortality didn’t reach statistically significant differences.  The only significant results found were for the pain scores recorded at 2 weeks and 1 month after discharge, the VAC stabilization being significantly better than traditional method. Conclusions: A larger study is required to establish if the advantages of the VAC assisted stabilization of the flail chest are superior to traditional treatment.