Surgical stabilization of rib fractures in conjunction with veno-venous ECMO for traumatic chest wall injury: a multi-institutional case series from the Chest Wall Injury Society (CWIS).

Introduction: Rib fractures are prevalent in 10% of blunt injury admissions and contribute significantly to trauma-related mortality. Severe cases, such as flail segments or multiple displaced fractures, frequently necessitate surgical stabilization of rib fractures (SSRF) to mitigate pain and improve outcomes. Pulmonary contusions, present in about 25% of chest wall injuries, can be exacerbated by severe rib fractures, leading to acute respiratory distress syndrome.

Extracorporeal Membrane Oxygenation During Surgical Stabilization of Rib Fractures in Successful Management of Severe Blunt Chest Trauma.

Early surgical stabilization of rib fracture (SSRF) improves outcomes in patients with flail physiology and severely displaced fractures. We present two cases of patients with severe chest injury and large flail segment who underwent SSRF while on veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patients developed respiratory failure within 24 hours of admission requiring VV-ECMO.

Intercostal nerve cryoablation during surgical stabilization of rib fractures decreases post-operative opioid use, ventilation days, and intensive care days.

Background: Intercostal nerve cryoablation is an adjunctive measure that has demonstrated pain control, decrease in opioid consumption, and decrease in hospital length of stay (LOS) in patients who undergo surgical stabilization of rib fractures (SSRF).

Methods: SSRF patients from January 2015 to September 2021 were retrospectively compared. All patients received multimodal pain regimens post-operatively and the independent variable was intraoperative cryoablation.

Atrial Cannulation During Resuscitative Clamshell Thoracotomy.

Background: Resuscitative thoracotomy and clamshell thoracotomy are performed in the setting of traumatic arrest with the intent of controlling hemorrhage, relieving tamponade, and providing open chest cardiopulmonary resuscitation. Historically, return of spontaneous circulation rates for penetrating traumatic arrest as well as out of hospital survival have been reported as low as 40% and 10%. Vascular access can be challenging in patients who have undergone a traumatic arrest and can be a limiting step to effective resuscitation.

Leadership skills curriculum development for residents and fellows: A needs-assessment.

Background: Non-technical skills (NTS) curricula have demonstrated success in surgical residencies. The purpose of this study is to examine the need for a structured leadership curriculum at our institution.

Methods: A needs-assessment survey analyzing the importance of leadership domains, previously validated by Kazley et al.

Are rib fractures stable? An analysis of progressive rib fracture offset in the acute trauma setting.

Background: Rib fractures serve as both a marker of injury severity and a guide for clinical decision making for trauma patients. Although recent studies have suggested that rib fractures are dynamic, the degree of progressive offset remains unknown. The purpose of this study was to further characterize the change that takes place in the acute trauma setting.

Teaching on Rounds and in Small Groups.

Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions.

Surgical stabilization of rib fractures in octogenarians and beyond-what are the outcomes?

Background: Prospective studies of surgical stabilization of rib fractures (SSRF) have excluded elderly patients, and no study has exclusively addressed the ≥80-year-old subgroup. We hypothesized that SSRF is associated with decreased mortality in trauma patients 80 years or older.

Methods: Multicenter retrospective cohort study involving eight centers.

Are We Out of the Woods Yet? The Aftermath of Resuscitative Thoracotomy.

Background: After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU.

Materials And Methods: We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers.

ICAM-1 is necessary for epithelial recruitment of gammadelta T cells and efficient corneal wound healing.

Wound healing and inflammation are both significantly reduced in mice that lack gammadelta T cells. Here, the role of epithelial intercellular adhesion molecule-1 (ICAM-1) in gammadelta T cell migration in corneal wound healing was assessed. Wild-type mice had an approximate fivefold increase in epithelial gammadelta T cells at 24 hours after epithelial abrasion.