Ann Thorac Surg 2000;70:343
© 2000 The Society of Thoracic Surgeons
Correspondence
Reply
Guglielmo M. Actis Dato, MDa,
Enrico Aidala, MDa,
Enrico Ruffini, MDa
a Piazza De Amicis, 121 bis, 10126 Turin, Italy
e-mail: actisdato{at}hotmail.com
To the Editor
We appreciate the opportunity to reply to the comments of Carbognani and colleagues regarding our article [1]. They stress and emphasize an important aspect of extensive flail chest injuries: the need to surgically stabilize the chest cage earlier than possible to reduce the time of mechanical ventilation support as an internal fixation, and subsequent complications.
The case discussed by Carbognani presented some worse aspects if compared with our case of anterior flail chest treated with the Sea Gull Wing Prosthesis [2]. In fact, the instability because of the anterior sternal disruption and the bilateral rib fractures, described by Carbognani and colleagues can be more difficult to treat to obtain a satisfactory stabilization. We agree with the technical choice to use Judet’s graffes in the more distal portions of the injured ribs, but on the other hand, we believe that, when possible, the use of a Sea Gull Wing Prosthesis presents some peculiar advantage if compared with a standard steel bar to sustain the anterior chest wall: 1) our prosthesis is self retaining and does not require any fixation thanks to the original conformation obtained by shaping the steel strut to work with his wings over the solid ribs and his concave body to sustain the fractured sternum. 2) It can be easily removed a few months later, through a small skin incision (Fig 1), which is more comfortable for the patient. In our experience we found that a surgical fixation of a complex flail chest can be often preferable to a medical therapy, but it was not so clear which is the best surgical technique [2]. As commented by Carbognani and colleagues "... the technical solution must be tailored to the single case ..." and we would add ... related to the surgeon’s personal experience.
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Fig 1. (A) Skin incision above the "wing" of the prosthesis. (B) Straight from the steel strut to facilitate the removal. (C) Steel strut extraction by a gentle traction.
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References
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Actis Dato G.M., Aidala E., Ruffini E. Surgical management of flail chest. Ann Thorac Surg 1999;67:1826-1827.[Free Full Text]
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Borioni R., Ciani R., Actis Dato G.M., Garofalo R. Surgical stabilization of the flail chest. Ann Thorac Surg 1992;54:397-398.[Free Full Text]
