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Toracoplastia traumática ¿tratamiento conservador o quirúrgico?
Traumatic Thoracoplasty: Conservative Treatment or Surgery?
María Garví López
, Ana M. Rodilla Fiz, M. Belén Lozano Serrano
Corresponding author
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Belén" "apellidos" => "Lozano Serrano" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de Albacete, Albacete, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Traumatic Thoracoplasty: Conservative Treatment or Surgery?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 652 "Ancho" => 909 "Tamanyo" => 90535 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Corte transversal, de la tomografía axial computarizada de tórax, mostrando segmento de costilla izquierda enclavado en el pulmón (flecha) con hemotórax asociado.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Presentamos el caso de un varón de 76 años que sufre accidente de tráfico de alta energía, llegó a urgencias intubado por insuficiencia respiratoria, con signos de traumatismo torácico y datos de hipoventilación izquierda. Se realizó TAC <span class="elsevierStyleItalic">total body</span>, que informó de fracturas posteriores y axilares de 3.<span class="elsevierStyleSup">a</span> a 12.<span class="elsevierStyleSup">a</span> costillas izquierdas, con enclavamiento en parénquima pulmonar, condicionando gran hematoma de pared torácica, contusión pulmonar y hemotórax (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). Se colocó tubo de tórax izquierdo con salida de 1.000<span class="elsevierStyleHsp" style=""></span>ml de sangre, con posterior control del sangrado y reexpansión pulmonar, sin precisar cirugía urgente. A los 5 días se destetó del respirador, se consiguió buen control del dolor mediante analgesia vía epidural y se decidió manejo conservador.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Por toracoplastia traumática entendemos un tipo de traumatismo torácico cerrado grave, que se caracteriza por la ausencia de movimiento paradójico, pues las fracturas costales se encuentran impactadas en el pulmón.</p><p id="par0015" class="elsevierStylePara elsevierViewall">La intervención se recomienda en aquellos casos en los que la única causa para mantener la ventilación mecánica (VM) sea el tórax inestable, así como en aquellos que deben ser intervenidos por otra causa y en los casos de una gran destrucción costal con necesidad de VM prolongada<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 652 "Ancho" => 909 "Tamanyo" => 90535 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Corte transversal, de la tomografía axial computarizada de tórax, mostrando segmento de costilla izquierda enclavado en el pulmón (flecha) con hemotórax asociado.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normativa sobre diagnóstico y tratamiento de los traumatismos torácicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Freixinet" 1 => "H. Hernández" 2 => "P. Martínez" 3 => "P. Moreno" 4 => "P. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(11)70011-4" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "41" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21300218" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical versus nonsurgical interventions for flail chest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Cataneo" 1 => "D.C. Cataneo" 2 => "F.H. de Oliveira" 3 => "K.A. Arruda" 4 => "R. El Dib" 5 => "P. de Oliveira Carvalho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "CD009919" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005300000005/v1_201704280943/S0300289616302770/v1_201704280943/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005300000005/v1_201704280943/S0300289616302770/v1_201704280943/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302770?idApp=UINPBA00003Z" ]
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