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Thoracoplasty: current application to the infected pleural space
1Division of Cardiothoracic Surgery, Case-Western Reserve University School of Medicine, Cleveland, Ohio.
Abstract:
Thoracoplasty, once commonly used in the management of cavitary pulmonary disease, continues to find application in the obliteration of infected pleural spaces. This study reports a series of 13 patients receiving thoracoplasty between 1976 and 1989. Five patients had chronic apical empyema spaces without prior resection of lung tissue. Two of the empyemas were due to tuberculosis, two were due to atypical mycobacteria, and one was due to postpneumonic empyema. All patients had extensive destruction of upper lobe tissue. Eight patients had undergone prior pulmonary resection; 3 had persistent infected spaces in the early postoperative period, 3 had development of empyemas and bronchopleural fistulas late (5 to 19 years) after pulmonary resection, and 2 had postpneumonectomy empyema. All patients had rigid cavity walls preventing space obliteration by rib removal alone and required concomitant resection of the thickened pleura and intercostal muscle tissues. Bronchopleural fistulas were present in 11 patients and were closed with adjacent nonintercostal muscle. All patients survived and had successful obliteration of the infected spaces with acceptable physiological and cosmetic results. We conclude that thoracoplasty remains a useful procedure in the management of the infected pleural space in select patients.
Insights
Thoracoplasty effectively obliterates infected pleural spaces, even in complex cases with prior surgeries or tuberculosis. This surgical technique remains a valuable option for managing persistent empyema and bronchopleural fistulas.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Infectious Diseases
Background:
- Thoracoplasty was historically used for cavitary pulmonary disease.
- Its current role includes managing infected pleural spaces.
Purpose of the Study:
- To evaluate the efficacy of thoracoplasty in patients with infected pleural spaces.
- To assess outcomes in patients with chronic empyema and bronchopleural fistulas.
Main Methods:
- Retrospective review of 13 patients undergoing thoracoplasty between 1976 and 1989.
- Inclusion of patients with chronic empyema, post-resection complications, and post-pneumonectomy empyema.
- Surgical technique involved pleural and intercostal muscle resection, with muscle flaps for bronchopleural fistula closure.
Main Results:
- All 13 patients survived the procedure.
- Successful obliteration of infected pleural spaces was achieved in all cases.
- Patients experienced acceptable physiological and cosmetic outcomes.
Conclusions:
- Thoracoplasty is a useful and effective procedure for managing select patients with infected pleural spaces.
- The technique is particularly valuable in cases with rigid cavity walls and bronchopleural fistulas.
- Thoracoplasty offers successful outcomes even in patients with complex histories of pulmonary resection.