■创伤后的肺疝是罕见的,关于最佳手术修复技术的共识仍然有限。虽然小的疝可以在不手术的情况下解决,在非手术治疗失败或并发肋骨骨折稳定的情况下,干预变得必要。修复中的网格应用带来了一个两难选择,经常提供身体支持,但引起感染的担忧,特别是在延迟闭合的创伤情况下。肋骨骨折的手术稳定,采用类似于骨科手术的硬件,可能需要预防性抗生素,尽管支持常规使用的经验证据很少。多发性创伤患者在有条理的手术计划中经常诉诸延迟的胸部闭合技术,但与立即关闭相比,这些都有潜在的后果。
方法:介绍了一个案例,涉及一名摩托车碰撞中的患者多处受伤,需要大量的输血方案,多次手术,包括延迟关闭胸部,受伤后四天,最终进行手术肋骨固定。在肋骨稳定期间,外伤性肺疝加重,强制网片修复,提示谨慎使用预防性万古霉素粉末以减轻感染风险。
结论:对文献的回顾显示,类似病例很少,尤其是那些伴有延迟闭合的肺疝,预防性抗生素和网状物在多发性创伤中的使用。
结论:该病例强调了在指导创伤患者肺疝和预防性使用万古霉素粉剂的手术决策方面缺乏深入的综合研究。
UNASSIGNED: Lung herniation following trauma is a rare occurrence, and consensus on optimal surgical repair techniques remains limited. While small herniations may resolve without surgery, intervention becomes necessary in cases of unsuccessful non-operative management or concurrent rib fracture stabilization. Mesh application in repair poses a dilemma, often providing physical support but raising infection concerns, particularly in trauma scenarios with delayed closure. Surgical stabilization of rib fractures, employing hardware similar to orthopedic procedures, may necessitate prophylactic antibiotics, though empirical evidence supporting routine use is scant. Polytrauma patients often resort to delayed chest closure techniques during methodical surgical planning, but these carry potential consequences compared to immediate closure.
METHODS: Presented is a case involving a patient in a motorcycle collision sustaining multiple injuries, necessitating a massive transfusion protocol, multiple surgeries, including delayed chest closure, and eventual surgical rib fixation four days post-injury. During rib stabilization, exacerbation of traumatic lung herniation mandated mesh repair, prompting the cautious use of prophylactic vancomycin powder to mitigate infection risks.
CONCLUSIONS: A review of the literature revealed a scarcity of similar cases, particularly those involving lung herniation with delayed chest closure, the use of prophylactic antibiotics and mesh in polytrauma.
CONCLUSIONS: This case underscores the lack of depth of comprehensive research guiding surgical decisions concerning lung herniation and the prophylactic use of vancomycin powder in trauma patients.