Concluded Case

Chest defect

A 25 yr, male pt presented with history of RTA; sustaining injury on left sude of chest. Xray s/o fractured ribs 5th, 6th, and 7th, with hemopneumothorax for which ICD was inserted. Within next 4-5 days, pt developed gangrenous patch at the site of injury along with pleural and pericardial effusion (on 2D echo).. how to manage?

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Concluded answer

On debridement the defect was muscle deep, involving the pec major and rectus sheath, thorough debridement was done and coverage was done with pedicled LD flap

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Traumatic haemopneumothorax dye to fractur ribs fracture ribs may be due injury lungs allowing air to accumulate in the chest cavity . After intercostal drainage the lung field expanded clearing the air in chest cavity . But after 4-5 days the blacky patch of skin over the injured part of chest wall may be due traumatic devitalisation of the skin either superficial layer of ski or full thickness. Debribement of the skin after development of full demarcation and regular dressing The pleural effusion developed may be due to incomplete drainage of the which leaked into pleural cavity or may due to infection or may be reactionary Pericardial effusion may be reactionary or due to infection if collected fluid in pericardium caused difficulty of pumping of heart then fluid may have to be removed by cardicentesis may be done under Ultra sound guided. Pleural may have to be drained by intercostel followed by culture sensitivity for appropriate antibiotic.

This gangrenous patch of skin is because of degloving injury causing devascularisation of skin Adv Excision of dear necrotic tissue Vacuum dressing May heal the wound Pericardial effusion need to be treated based on its merit, it it is causing decreased functioning of heart then it can be tapped

Thoracoscopic drainge of effusion (pleural/pericardium) and placement of chest tube followed by excision of the patch and reconstruction (based on your suitability).If fractured ribs are displaced then figure of eight nonabsorbable suture for reapproximation or titanium plates

Nothing ..just debride the dead , necrotic tissue ..better by a plastic sx , he knows better the level of debridement and then coverage with skin graft or local flap coverage

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On debridement the defect was muscle deep, involving the pec major and rectus sheath, thorough debridement was done and coverage was done with pedicled LD flap