title: Addition of Video-Assisted Thoracoscopic Surgery to the Treatment of Flail Chest.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) is increasingly used in chest trauma for diagnostic and therapeutic purposes. In this report we describe our single-institutional experience with VATS in the surgical treatment of patients with flail chest after high-energy trauma.
  
  
  METHODS
  From January 2013 to July 2014, 15 patients with flail chest after high-energy trauma were treated in our hospital. The Injury Severity Score (ISS) ranged from 16 to 44. Rib fixation was performed with precontoured plates or intramedullary splints. In all, patients we additionally used VATS to explore the thoracic cavity and evacuate any hemothorax.
  
  
  RESULTS
  In 10 patients a prominent hemothorax was present, which needed evacuation. The median operative time was 120 minutes (range, 60 to 180 minutes), with a median blood loss of 150 mL (range, <100 to 400 mL). The mean stay in the intensive care unit was 5.27 days (SD 6.79). Ten patients were extubated directly after operation in the operating room. The other 5 patients were extubated after 1 to 13 days. The mean duration of mechanical ventilation was 2 days (SD 4.17). No patient required a tracheostomy. Three patients had minor postoperative adverse events. All patients were discharged after 6 to 44 days (mean, 11.9 hospitalization days) (SD 9.57).
  
  
  CONCLUSIONS
  We believe VATS is effective and safe and can be of additional value by providing the possibility to adjust the planned incision for rib fixation and decrease the area of muscle destruction. Additional pulmonary or mediastinal pathologic conditions can be identified and complete evacuation of hemothorax can be achieved simultaneously.
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands. Electronic address: judith.schots@gmail.com.
authors.forename: Judith P M
authors.initials: JP
authors.lastname: Schots
authors.affiliation: Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Yvonne L J
authors.initials: YL
authors.lastname: Vissers
authors.affiliation: Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Karel W E
authors.initials: KW
authors.lastname: Hulsewé
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Berend
authors.initials: B
authors.lastname: Meesters
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hustinx
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Annette
authors.initials: A
authors.lastname: Pijnenburg
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Siebenga
authors.affiliation: Department of Surgery, Division of Trauma Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Erik R
authors.initials: ER
authors.lastname: de Loos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005409:Flail Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012121:Respiration, Artificial; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D055815:Young Adult