Chest wall injury centers offer streamlined access to advanced surgical and non-surgical techniques

Developing a Chest Wall Injury Center: A Roadmap

Improved technology and techniques offer patients with acute and chronic chest wall injuries a wider range of surgical and non-surgical options. In a letter to the editor¹ in the Journal of Thoracic Disease, Evert Eriksson, M.D., a general surgeon specializing in injuries to the chest wall at Medical University of South Carolina, joins others to describe pathways to success in developing chest wall injury centers (CWICs) at their respective institutions.

Streamlining access and workflows for the treatment of patients with chest wall injuries is the goal of CWICs. With the ability to deliver multidisciplinary care in a collaborative environment, these centers offer patients, institutions, and providers with a host of benefits.

“These centers and corresponding services may help improve and standardize care of the patient with chest wall injury, are financially-responsible, and provide a necessary opportunity to train the next generation of passionate chest wall surgeons and health care providers," the authors write.

Features of the CWIC concept include:

• Caring for chest wall injury patients across the healthcare continuum. The ideal CWIC offers consultations and second opinions, outpatient services, and inpatient care with the ability to perform expedient surgical interventions when indicated.
• Rapid evaluation of chest wall injuries. Ideally, procedures such as surgical stabilization of rib fractures (SSRF) should be performed within 72 hours of injury unless prohibited by other injuries or patient psychology. Designing a workflow that enables operating room access for acutely injured patients is critical to a well-functioning CWIC.
• Multidisciplinary care. Specialists collaborate to provide care from their respective fields of trauma, orthopedic, and thoracic services, physical therapy, and pain management.
• Adequate surgical staffing. Having at least two or three qualified chest wall surgeons on staff provides the necessary coverage to adequately care for patients in consultation, inpatient, and outpatient settings, even though only one surgeon is required to become a CWIC.
• Enhanced follow-up services. Outpatient follow-up services should include all standard procedures, as well as those particular to the management of chronic issues and complications such as hardware failure, screw migration, non- or mal-union of ribs or sternal fractures, intercostal or other chest wall hernias, diaphragmatic hernias, and costal margin injury which could range from slipped rib to costal margin rupture. These circumstances require a dedicated clinic space staffed with appropriate nursing and advanced care providers, as well as access to a team of multidisciplinary specialists available both in-person and via telehealth.

Currently, there are relatively few CWICs nationally. These programs require institutional buy-in, the development of guidelines and workflows, and the establishment of various protocols and credentialing processes. It is imperative to become a member of a surgical society with experience in traumatic chest wall surgery, such as the Chest Wall Injury Society, and identify a committed mentor to assist in setting up a CWIC program.

About the MUSC Health Chest Wall Injury and Reconstruction Center

Recognized as a Chest Wall Injury Collaborative Center with the Chest Wall Injury Society, MUSC Health proudly serves as a resource for our colleagues around the region. To refer a patient, please sign in to MUSC Health CareLink. If you are not yet a member of MUSC Health CareLink, you can call MEDULINE, which is MUSC Health's consultation line exclusively for health care professionals. This resource is available 24 hours a day, seven days a week by calling 843-792-2200 or 800-922-5250.

Reference:
1. Forrester JD, Bauman ZM, Doben AR, Eriksson EA. Chest wall injury centers - how we did it. J Thorac Dis 2021. doi: 10.21037/jtd-21-1198