Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 11 , ISSUE 2 ( May-August, 2022 ) > List of Articles


Are Post-COVID-19 Sequelae a Challenge for Chest Wall Reconstruction in Flail Chest? A Case Report

Juan Manuel Lopez Lopez

Keywords : ARDS, COVID-19, Flail chest, Lung injury, Pulmonary fibrosis, Rib fixation, Rib fracture, SARS-CoV-2

Citation Information : Lopez JM. Are Post-COVID-19 Sequelae a Challenge for Chest Wall Reconstruction in Flail Chest? A Case Report. Panam J Trauma Crit Care Emerg Surg 2022; 11 (2):95-98.

DOI: 10.5005/jp-journals-10030-1383

License: CC BY-NC 4.0

Published Online: 31-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: The SARS coronavirus-2 (SARS-CoV-2), responsible for COVID-19, with millions of infections that continue to accumulate, as well as the growing concern about chronic respiratory symptoms and changes in pulmonary fibrosis in recovered population. Rib fixation is indicated in patients with a flail chest who do not require mechanical ventilation, since they may develop chronic pain and thoracic deformity with a decrease in quality of life and incapacity for work. Selective mechanical ventilation with double-lumen tubes helps to collapse the lung on the side to be fixed, allowing the surgeon to preserve anatomical structures, making a better dissection. Case description: A 60-year-old male, diabetic, history of COVID-19, previous 3 months, later depression; cyclist, fell on a retaining wall on 20th October 2020, assessed in a hospital where he was discharged from the emergency room with analgesics, without improvement, for which he went to the social security hospital where they found right rib fractures, monitored in the emergency room for 72 hours with poor analgesic response [Numeric Pain Intensity (NPI) 8–9/10], depending on oxygen at 5 L/min for SatO2 = 90%. He was transferred to our hospital on 23rd October 2020, tomography with bilateral rib fractures (1°–9° right and 2°–5° left), right flail chest, bilateral pulmonary fibrosis (post-COVID-19), and right pleural effusion. The third, fourth, fifth, sixth, seventh, eight, and ninth right ribs with the StraCos system; it was impossible to perform surgery with right lung exclusion since, due to pulmonary fibrosis, the patient presented desaturations <80% with hemodynamic repercussions. He removed supplemental oxygen at 96 hours postoperatively and endopleural catheter at 7 days. Conclusion: The SARS-CoV-2 infection has left many lessons, and a great way to discover; it has collapsed health systems and has also had a negative impact on the quality of care for the polytraumatization of the chest in the emergency room. We face real challenges when operating patients with unusual ventilatory parameters for trauma patients, with slow postoperative recovery, and increased costs.

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