Large Penetrating Wounds to the Chest Managed With Immediate Chest Wall Reconstruction Using Biologic Mesh, Titanium
John P Shillinglaw1, Cory J Nonnemacher1, Dudley B Christie1
1Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA.
The American Surgeon
|April 10, 2024
Summary
Managing large open chest wounds with exposed lung is challenging. Immediate reconstruction using biologic mesh and titanium plates showed no increased infection risk in 4 trauma patients.
Area of Science:
- Thoracic surgery
- Trauma surgery
- Reconstructive surgery
Background:
- Large open chest wall wounds present complex management challenges due to full-thickness tissue loss, rib fractures, and exposed lung.
- Historically, synthetic materials were avoided in traumatic thoracic injuries due to infection concerns.
Observation:
- This study presents 4 patients with large open thoracic injuries (1 blunt, 3 penetrating trauma).
- Initial management involved prompt surgical repair using biologic mesh, titanium rib spanning plates, and rotational tissue flaps with Z-plasty for closure.
Findings:
- All 4 patients experienced successful post-operative recovery without complications or wound infections.
- Immediate reconstruction utilizing biologic mesh and titanium rib spanning plates appears feasible and safe.
Implications:
- These findings suggest that immediate reconstruction with biologic mesh and titanium plates may be advantageous for large open thoracic injuries.
- This approach may offer a lower risk of infection than previously believed, challenging historical surgical dogma.
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