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

Abstract

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.