[Re-operation for Inflammatory Lung Diseases]

Two types of re-operations for inflammatory lung diseases are presented:thoracoplasty and cavernostomy. Thoracoplasty is used to obliterate a residual pleural space after upper lung resection with prolonged air leak. Usually, the 2nd to the 6th ribs are resected, according to the extent of the space. Posteriorly the ribs should be removed to the costotransverse joint to achieve sufficient space obliteration. The tip of the scapula is resected in case of the resection of the 6th rib, otherwise the scapula would impinge on the 7th rib. The resection of the 1st rib should be avoided because of a subsequent severe scoliosis. Cavernostomy is a procedure to open the infected cavity of the residual lung. Aspergillus and non-tuberculous mycobacteria are the most frequent pathogens. The site of skin incision depends on the location of the cavity:midaxially incision for an anterior cavity and paravertebral incision for a posterior cavity. Cutting "septum" in the cavity makes it a single space, contributing to sufficient drainage by gauze. The closure of the cavity will be considered after several months or years when the cavity is sterilized and the patient's nutritional status becomes well. These 2 procedures are effective in treating refractory lung inflammation after lung resection, although they are quite traditional.