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The modern use of thoracoplasty

Annals of Thoracic Surgery 40(2): 181-187

The modern use of thoracoplasty

Thoracoplasty is a time-honored but, at present, rarely indicated procedure for reducing thoracic cavity vol. This study reviews a series of 30 patients treated with thoracoplasty over a 14 yr period (1970-1983). Indications were to close a persistent pleural space in 28 patients and to tailor the thoracic cavity to accept diminished lung volume concomitant with a pulmonary resection in 2 patients. Persistent pleural space, often associated with a bronchopleural fistula (24 patients), occurred after operation in 19 patients: following pulmonary resection in 17 patients, resection of mesothelioma in 1 patient and following decortication without resection in 1. In the remaining 9 patients with a persistent pleural space, problems, developed from primary lung destruction due to tuberculosis (4 patients), postpneumonic empyema (1 patient) or as late infection of a residual pleural space many years after therapeutic pneumothorax and collapse therapy for tuberculosis (4 patients). The overall success rate of thoracoplasty in eliminating intrathoracic space problems was 73%. There was 3 deaths (10%) and 5 failures to heal, representing a 33% failure rate in the 1s half of the series (to 1976) and a 17% failure rate thereafter (1 death and 1 nonhealing patient). The primary underlying disease was tuberculosis in 23 patients, 8 of whom had concomitant aspergilloma and 1, atypical tuberculosis. The failures were analyzed and reviewed to clarify the principles for the successful use of thoracoplasty. Thoracoplasty is a rarely required salvage-type procedure applicable to moderately debilitated patients in whom it is considered desirable to eliminate open drainage. Timing, appropriate staging and anatomical understanding of thoracoplasty are important in achieving its goal of obliteration of space and final resolution of empyema.

Accession: 006719545

PMID: 4026450

DOI: 10.1016/S0003-4975(10)60016-1

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