Thoracic flailing is a severe complication of blunt force trauma to the chest, causing part of the chest wall to separate and move in the opposite direction. It can lead to breathing difficulties and internal injury. Treatment involves pain management, mechanical ventilation, and surgery.
Thoracic flailing is a very serious complication of blunt force trauma to the chest, such as that sustained in an automobile accident, which can lead to death if left untreated. In patients with this lesion, part of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall. This makes the chest appear to jerk or squirm as the patient breathes, explaining the name. This condition has been observed and discussed by the medical community for hundreds of years.
For the chest to develop, the patient must have multiple sets of broken ribs. The ribcage and sternum are deliberately designed to be extremely robust, as they protect some very delicate organs. When multiple sets of fractures occur in the right places, part of the chest wall separates, causing an instability to develop. When the patient inhales, the separated section moves inward, against the outward motion of the chest, and when the patient exhales, the separated section protrudes, rather than sinking in with the rest of the chest.
Patients with chest flail usually have difficulty breathing and are at risk of internal injury from movement of the separated piece of chest wall. Their chests are often bruised from the wounds that caused the injury, and their chests are usually very tender to the touch. The injury also indicates that the patient may have underlying trauma such as damage to the lungs or heart, which may contribute to the patient’s respiratory distress.
Historically, thoracic flail was considered an extremely serious complication, both because of the underlying damage associated with it and because of the problems caused by a severed chest wall. A variety of treatments have been used to manage the injury, with varying levels of effectiveness, and patients have often experienced a long and traumatic recovery period if they have survived the initial seizure.
Modern treatment for thoracic flail involves a thorough examination to determine the extent of the damage, coupled with the administration of pain management medications to keep the patient comfortable. In cases where patients experience severe breathing difficulties, mechanical ventilation can be used to keep the patient adequately oxygenated. Once the patient is stabilized, surgery can be used to address the flail chest. After surgery, the patient may need to spend a lot of time resting to give the broken ribs a chance to heal effortlessly.
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