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   Table of Contents - Current issue
Coverpage
January-December 2022
Volume 7 | Issue 1
Page Nos. 1-22

Online since Friday, December 30, 2022

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EDITORIAL  

Is flail chest correctly defined: A new definition is suggested Highly accessed article p. 1
Moheb A Rashid
DOI:10.4103/jctt.jctt_9_22  
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REVIEW ARTICLE Top

Management of rib fractures following blunt chest wall trauma: Are we there yet? p. 2
Bhavik Patel
DOI:10.4103/jctt.jctt_5_22  
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ORIGINAL ARTICLES Top

Postoperative outcomes following surgical stabilization of rib fractures stratified by 5-factor modified frailty index p. 4
Nirvana Saraswat, Nicole Werwie, Jin Wu, Danielle Hery, Emily Saunders, Hannah Bundy, John O Elliott, Brent Goslin, William DeVoe
DOI:10.4103/jctt.jctt_1_22  
Objectives: Surgical stabilization of rib fractures (SSRF) improves outcomes in patients with flail chest and displaced fractures with impaired pulmonary function. Elderly and frail patients with such injuries are at risk for significant morbidity and may benefit from SSRF. The 5-factor modified frailty index (mFI-5) is a validated predictor of postoperative outcomes. The purpose of this study is to evaluate the relationship between frailty and outcomes following SSRF at a tertiary care trauma center. Methods: A retrospective review of patients undergoing SSRF from 2015 to 2019. Patients over 18 years old with two or more displaced fractures were included in the study. Exclusion criteria were isolated fracture, traumatic brain injury, and pulmonary contusion. Frail patients were defined by an mFI-5 score 2 or greater. Chi-square analysis, Fischer's exact test, and Student's t-test were used for comparative analysis as appropriate. P < 0.05 was considered statistically significant. Results: One hundred and fifty-four patients met inclusion criteria. Forty-eight patients were designated frail and 106 nonfrail. The mean number of fractures was similar between frail and nonfrail groups (7.0 vs. 7.3, P = 0.685). Injury Severity Score was lower in the frail group (14.5 vs. 17.8, P = 0.02). Inpatient mortality (P = 0.312), rates of pneumonia, end-organ dysfunction, and surgical site infections were similar (P > 0.05). Intensive care unit admission (47.9% vs. 29.2%, P = 0.025) and tracheostomy rates (P = 0.009) were increased in the frail group. Frailty also increased the risk of prolonged mechanical ventilation >48 h on multivariate analysis. Conclusion: Frail patients, stratified using mFI 5 score, experienced similar rates of multiple postoperative outcomes, including mortality, but had increased rates of prolonged ventilation and tracheostomy. Despite observed but expected increased morbidity in these patients, the similar complication and mortality rates suggest a role for surgical stabilization of severe rib fractures in frail patients.
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Factors associated with early complications of surgical management due to penetrating laryngotracheal trauma in Colombia p. 10
Mario-Fernando Lopez, Stella-Isabel Martínez, Carlos-Andres Carvajal
DOI:10.4103/jctt.jctt_4_22  
Background: This investigation aimed to describe factors associated with early complications of surgical management due to penetrating laryngotracheal trauma in Colombia. Materials and Methods: A descriptive and retrospective cohort study was carried out; bivariate analysis using Pearson's Chi-square and Fisher's exact test was utilized to find associations with morbidity outcomes. Results: Between 2005 and 2019, 50 patients with penetrating laryngotracheal injuries underwent surgery; the median age was 29.5 years (interquartile ranges = 24.0–39.7), wherein 92% were male. The trachea was the most affected organ in 74% of patients, and lesions associated with laryngotracheal trauma were reported in 50% of patients. Cervicotomy was the surgical approach in 92% of patients. The 30-day overall morbidity was 24%, and mortality was 6%; dehiscence of the primary repair, or anastomosis, was present in 10% of the patients: 2% partial and 8% complete. Dehiscence was associated with infection (P = 0.002). Early stenosis was described in 10% of the patients; association was found between stenosis and dehiscence (P = 0.001), infection (P = 0.001), and reoperation (P = 0.001). Finally, infection was present in 8% of the patients and was indeed associated to the requirement of postoperative intensive care unit (ICU) hospitalization (P = 0.003). Conclusions: Limited information is available about factors related to early complications in laryngotracheal trauma. Nonetheless, in this series, a statistically significant association was found between early dehiscence of the primary repair, or anastomosis, and infection. Moreover, early stenosis was associated with dehiscence, infection, and reoperation. Finally, early infection was associated with the requirement of postoperative ICU hospitalization.
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Minimal invasive approach for rib fractures: Feasibility and safety in a single-center experience p. 15
Miguel Alejandro Martinez Arias, Ulises Loyola Garcia, Juan Antonio Omana Toledo, Linda Sofía Mercado Mercado Sanchez
DOI:10.4103/jctt.jctt_6_22  
Background: Current pathologies and the concepts applied for chest trauma, both for revision of thoracic cavity and to solve same traumatisms, have allowed to develop minimal surgery approach techniques for the resolution of multiple nosologies, thanks to their various benefits, currently this has been classified as a vanguard surgical technique worldwide. Material and Methods: Patients undergoing ribs fixation with minimal invasive technique, at ISSEMYM Medical Center, Thoracic Surgery Service, were analyzed according to age, gender, number of ribs fixed, days of hospital stay, days with endopleural tube, type of anesthesia, and complications. We present a series of cases with retrospective, descriptive design in a period of 72 months. Results: This is the largest case series reported for fixing ribs by minimal invasive approach, a final sample n = 103 was used, and favorable results and description of the same technique were described. The analyzed number of fixed ribs presented an average of 3.8 ribs fixed per patient. The average of hospital stay days was 5.08 days, after the procedure. Moreover, the oldest patient undergoing this procedure was 89 years old and the youngest was 23 years old. Conclusions: The technique of fixing ribs by minimal invasive approach continues to be a choice technique to reduce postoperative complications and reduce days of hospital stay, it is a reproducible, safe and pioneering technique for chest surgery, even in geriatric patients.
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IMAGES IN CARDIOTHORACIC TRAUMA Top

Posttraumatic pulmonary abscess p. 21
Moheb A Rashid
DOI:10.4103/jctt.jctt_7_22  
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SURGICAL TECHNIQUES AND VIDEOS Top

Aortic cross-clamping in resuscitative thoracotomy: Pitfalls, tips, and tricks p. 22
Moheb A Rashid
DOI:10.4103/jctt.jctt_8_22  
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