Thoracoplasty in the current practice of thoracic surgery: a single-institution 10-year experience

We retrospectively reviewed our recent experience with thoracoplasty to define its role in the context of current surgical practice.

Twenty-six patients underwent thoracoplasty in the last 10 years with the aim of obliterating a residual pleural space or pulmonary cavity. Twenty-one patients had a postresectional empyema, 3 had a primary empyema and 2 had a cavernostomy performed for a pulmonary aspergilloma. A bronchopleural fistula was present in 10 cases. Infection had been previously controlled in all cases by intercostal drainage, open-window thoracostomy, or cavernostomy (in 4, 20, and 2 patients, respectively). Twenty-two extramuscoloperiosteal thoracoplasties, 3 thoracomyoplasties, and 1 Andrews thoracoplasty were performed. Intrathoracic flap transposition followed thoracoplasty in 9 cases; a second step of the Clagett procedure followed thoracoplasty in 2 cases.

One patient died postoperatively (3.8%). Thoracoplasty alone (n=6) or combined with a procedure to fill the residual space (n=14) was successful in achieving complete obliteration of the residual space in 77% of patients (n=20). In 4 patients thoracoplasty alone reduced the residual cavity but filling procedures were not feasible. In 1 patient thoracoplasty failed to obliterate the cavity and infection recurred. Three patients experienced chronic thoracic sequelae.

Thoracoplasty remains an option for the treatment of residual pleural or pulmonary spaces (with or without bronchopleural fistula) once infection has been controlled, when other more conservative procedures are not effective or feasible. In our experience it was effective both when used alone in favorable conditions and when combined with other procedures to fill the residual cavity.