Materials and methods We report a case of TW reconstruction

with Bard CollaMend® (Davol, Cranston, RI) in a patient victim of trauma. A retrospective review was conducted of all reported cases of use of biological prosthesis in TW reconstruction in trauma published up to September, BYL719 price 2012 on PUBMED (1966–2012), using the key words, “thorax, reconstruction, biological, trauma”. Results Literature review No other reports exist about the TW reconstruction in trauma with biological prosthesis. Case report A 47 years old male transported to the Emergency dept. of our hospital after a car crash. At the arrive in ER the patient was shocked with a bi-lateral pneumothorax, multiple rib fracture (II-III-IV-V-VI) with flail-chest on the right side (Figure 1), haemo-peritoneum and an exposed fracture of the right femur. Bilateral thoracic drains

were immediately positioned and the patient was then transferred to the theatre for an explorative laparotomy and liver packing. Two days after Histone Methyltransferase inhibitor the packing have been Selleck MK-0457 removed and the flail-chest (III and IV ribs) was fixed with titanium devices. The femur fracture was temporarily treated with external fixator. Ten days after the intervention the postoperative course was complicated by a biliary fistula treated with ERCP and biliary endo-prosthesis positioning. During the ICU recovery the patients developed ARDS and chest wound infection. Blood samples and chest wound cultures Dolutegravir order demonstrated infection by Aspergillus Fumigatus and Pseudomonas Aeruginosa MRSA respectively. The antibiotic treatment have been immediately addressed. 21 days after the intervention the patient have been re-operated for hemorrhagic shock from erosion of the

right internal mammary artery by the rib margin. Surgical haemostasis was necessary. Free segment of the III and IV ribs were removed. Due to the infection titanium devices were removed too and the defect (7×8 cm) was repaired using a biologic mesh (CollaMend®, 18×23 cm) fixed to the thoracic wall with PDS-0 interrupted suture (Figure 2). 9 days after the second intervention a thoracic-abdominal CT-scan was performed (Figure 3). It documented no thoracic pathologic findings, satisfactory post-surgical results and a left hepatic artery post-traumatic pseudo-aneurism treated with angio-embolization. Femur fracture was then definitively treated with endomidollar pin positioning. Chest wound infection was treated with medication and healed completely in four weeks (Figure 4). 18 months after the discharge the patient is well and with documented no respiratory impairment. Figure 1 Pre-operative CT-scan. Figure 2 Reconstruction scheme with biological prosthesis. Figure 3 CT-scan 9 days after the reconstruction; the red arrow indicates the prosthesis. Figure 4 The complete healed thoracic wound.