Chest wall injuries

Management of chest wall injuries is primarily supportive in nature. Patients with large open wounds to the chest should have operative debridement and closure in conjunction with drainage of the pleural space. Patients with flail chest do not require specific therapy directed toward the flail segment; rather, their need for mechanical ventilation is related to the underlying pulmonary contusion or other parenchymal injury. Injuries of the first and second ribs are generally due to a substantial transmission of force, and are associated with injuries to the great vessels of the thoracic outlet. However, in the absence of suggestive clinical signs or evidence of mediastinal hemorrhage on the initial chest radiograph, these injuries alone are not an indication for invasive vascular studies. Sternal fractures suggest the possibility of an underlying myocardial contusion, but are of little consequence by themselves.

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