“Air Plombage” With Resection for Pulmonary Tuberculosis: A Technique for Decreasing Complications

Pate, James W.; Hughes, Felix A.; Campbell, Roger E.; Reisser, John M.

doi:10.1016/s0096-5588(20)30040-4

Cited by 9 publications

(4 citation statements)

References 1 publication

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“…This method creates an extrapleosteal space where the accumulated exudate can be gradually absorbed over time, facilitating re-expansion of the collapsed lung, and improving lung function. It also preserves the bony thorax, avoiding chest wall deformities [ 1 , 2 ]. However, if the extrapleosteal space becomes infected, it can lead to the development of new empyema.…”

Section: Discussionmentioning

confidence: 99%

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report

Kuramochi,

Shinonaga,

Kuraoka

2024

surg case rep

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Background Refractory pyothorax caused by methicillin-resistant Staphylococcus aureus (MRSA) is a challenging clinical condition; complications such as bronchopleural fistulae can further hinder its treatment. To avoid a fatal state caused by aspirating pneumonia, open window thoracotomy is not only sometimes performed, but subsequent closure of the window can also be difficult. In this report, we describe the case of a patient with MRSA pyothorax with bronchopleural fistula in whom a successful closure of window thoracostomy was achieved by utilizing Endobronchial Watanabe Spigot　(EWS; Novatech, La Ciotat, France) bronchial occlusion and a modified extraperiosteal air plombage technique. Case presentation A 66-year-old man underwent an open window thoracotomy for pyothorax with bronchopleural fistula with MRSA infection at the age of 59. After 7 years, he was referred to our department for the closure of the window. Initially, we occluded the right B6a + b by EWS under bronchoscopy. Subsequently, we dissected the intercostal muscles between the 3rd, 4th, 5th, and 6th ribs to collapse the pyothorax cavity and ensure the coverage of the fistula of lung including the hypertrophied parietal pleura and soft tissues of the chest wall. We filled the extrapleosteal space with a pedicled anterior serratus muscle flap to compress the parietal pleura. Postoperatively, lung expansion was satisfactory, and there has been no recurrence for 6 years since the window closure surgery. Conclusions We were able to achieve closure and healing in a patient who underwent open window thoracostomy for MRSA bronchopleural fistula by applying EWS and modified extraperiosteal air plombage technique.

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Section: Discussionmentioning

confidence: 99%

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report

Kuramochi,

Shinonaga,

Kuraoka

2024

surg case rep

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“…The pleura, periosteum, and intercostal muscles and facia drop into the pleural space and contact the resected surface of pulmonary parenchyma. Pate et al (6) claimed no drainage of this space was done, but we usually place the 19-Fr Blake Silastic Drain ® (Ethicon; Somerville, New Jersey, USA) into the pleural space (13). The drainage is under negative pressure of 10 cmH 2 O and is removed on postoperative day 14 after confirming no air leak.…”

Section: Tips On Surgical Technique and Perioperative Managementmentioning

confidence: 99%

“…Moreover, in late phase after air plombage, the thoracic wall without the intercostal muscles as "supporter" commonly develops atrophic and deformative changes (14). Additionally, the stripped portion of the ribs must be intact to prevent intrapleural contamination of the space with resultant infection (6). To minimize this unfavorable sequela, it is important to avoid dissecting the costal periosteum and intercostal muscles of lower (the 8th-12th) ribs (6).…”

Section: Tips On Surgical Technique and Perioperative Managementmentioning

confidence: 99%

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Second surgery for complications of major pulmonary resection: the knack of air plombage in thoracoplasty

Kamiyoshihara¹,

Igai²,

Yazawa³

2022

Shanghai Chest

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Air plombage is a surgical procedure that reduces the pleural space. In 1953, Dr. Chamberlain designed the original "extraperiosteal plombage" to prevent complications after pulmonary segmentectomy for tuberculosis. This surgical technique was developed to prevent the formation of an intrapleural pocket of dead space, and allow collapse of the cavity and obliteration of the extrapleural space. Thus, this technique has been called as "(extraperiosteal) air plombage." In Japan, a modified air plombage called "Kinchu method" has been performed. The indication for air plombage is as follows: (I) the remaining pulmonary parenchyma after resection does not expand and fill the residual pleural space, (II) large raw surfaces of pulmonary parenchyma remain in a plane, which cannot easily contact the chest wall, (III) there is an excessive air leak from the parenchyma. Surgical procedure is as follows: portion of the ribs above the pleural space are stripped subperiosteally, leaving attached periosteum on their outer surfaces. The size, shape, and location of the "resultant air pocket" is made to fill the defect left by lung resection. The pleura, periosteum, and intercostal muscles and facia drop into the pleural space and contact the resected surface of pulmonary parenchyma. However, care should be taken with regards to pre-, intra-, and post-operation. Particularly, to minimize atrophic and deformative changes in late phase after air plombage, it is important to avoid dissecting the costal periosteum and intercostal muscles of lower (the 8th-12th) ribs.

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Omentoplasty in thoracic surgery

Kitano

2008

Gen Thorac Cardiovasc Surg

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Plombage methods were designed for treating pulmonary tuberculosis surgically around 1945 when pulmonary tuberculosis was regarded as a "traitor disease" in Japan. Nagaishi had reported extrapleural synthetic resin ball plombage in 1948 as the world's first case, but it was complicated by empyema due to perforation of cavities and rupture of lesions because the resin ball was hard. Later, fillers were improved by using soft material. At the present time, only air plombage and omentoplasty remain. Especially the latter has gained widespread use in the thoracic surgery field and become a standard procedure. Chronic empyema with bronchopleural fistula sometime requires surgical treatment despite the development of various antibiotics, but highly stressful surgery that can cause reduced pulmonary function or thoracic deformity must be avoided. Therefore, one-stage omentoplasty utilizing such omental multi-functions as hose action, angiogenesis, sucker action, and the immune reaction has been found to have clinical significance for thoracic empyema and its complications. This method is described in detail.

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“Air Plombage” With Resection for Pulmonary Tuberculosis: A Technique for Decreasing Complications

Cited by 9 publications

References 1 publication

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report

Second surgery for complications of major pulmonary resection: the knack of air plombage in thoracoplasty

Omentoplasty in thoracic surgery

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