Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption.