Thoracoplasty in the context of current surgical practice

Peppas, George; Molnár, Tamás; Jeyasingham, K.; Kirk, Alan B.

doi:10.1016/0003-4975(93)90353-j

Cited by 52 publications

(32 citation statements)

References 10 publications

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“…Thoracoplasty in combination with muscle tlap transposition has been applied successfully to achieve pleural space obliteration in patients presenting chronic post-lobectomy empyema [ 10,[17][18][19][20][21][22]. This complex pathological entity is increasingly observed in the context of pulmonary resections performed after radiochemotherapy or resections realized in immune-deftcient patients.…”

Section: Discussionmentioning

confidence: 99%

“…This complex pathological entity is increasingly observed in the context of pulmonary resections performed after radiochemotherapy or resections realized in immune-deftcient patients. In these situations, the pleural space usually contains polymicrobial infections including multi-resistant germs or aspergillus fumigatus [ 16,18,19] which requires efficient space obliteration with healthy vascularized tissues in order to obtain permanent infection control.…”

Section: Discussionmentioning

confidence: 99%

“…This holds especially true in the presence of a broncho-pleural fistula or the colonization of the residual cavity by multi-resistant germs or Aspergillus fi1111igat11s where complete space obliteration is of paramount importance to achieve permanent contrai of infection. ln case of a chronic post-resection empyema open window thoracostomy [ 1 O] may therefore be required with packing of the cavity or treatment by vacuum assisted wound management' 1 followed by space obliteration either by intrathoracic omentum [ 12] of muscle transfer [13][14][15] or tailored thoracoplasty [16][17][18][19][20] or a combination ofboth (thoracomyoplasty) [21,22). Although there is some recrudescence in the recent literature for thoracomyoplasty and its raie in the modern thoracic surgery armamentarium, very few reports focus on its specific use for the treatment of chronically infected pleural spaces after lobectomy which are increasingly observed in our days in the context of neoadjuvant or adjuvant radio-chemotherapy applied for locally advanced NSCLC, or after lobectomy performed in immunodeficient patients.…”

Section: Introductionmentioning

confidence: 99%

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Tailored Thoracomyoplasty as a Valid Treatment Option for Chronic Postlobectomy Empyema

Fournier

Krueger

Wang

et al. 2012

The Annals of Thoracic Surgery

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Background: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients ( 11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Resu!ts:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEY l of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy. Conclusions AbstractBackground: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients (11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). ln 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Results:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEVI of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scolios...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tailored Thoracomyoplasty as a Valid Treatment Option for Chronic Postlobectomy Empyema

Fournier

Krueger

Wang

et al. 2012

The Annals of Thoracic Surgery

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“…This technique has been applied to obliteration of the pleural space. 30,31 Thoracoplasty is performed alone or with myoplasty or omentoplasty, depending on the extent of empyema and the presence of a bronchopleural fi stula. 32 Myoplasty and omentoplasty are the procedures for obliterating the pleural space using muscle fl aps and omental fl aps.…”

Section: Obliteration Of Pleural Spacementioning

confidence: 99%

Surgical treatment of chronic empyema

Shiraishi

2010

Gen Thorac Cardiovasc Surg

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Empyema remains challenging for thoracic surgeons. This review covers diverse aspects of acute empyema and chronic empyema and its surgical treatment. The triphasic nature of thoracic empyema (stages I, II, and III) is also addressed. The principles of empyema treatment are early diagnosis and early treatment. For acute empyema (empyema in stages I and II), early surgical intervention, such as video-assisted thoracoscopic débridement, is recommended when conventional chest tube drainage has failed. Radical treatments of chronic empyema (empyema in stage III) include (1) removal of the empyema space (decortication with or without lung resection) and (2) obliteration of the pleural space with muscle flaps or omentum flaps, or by thoracoplasty. Decortication is the procedure of choice for patients with reexpandable underlying lung. When bronchopleural fistula exists in the underlying lung, the fistula should be securely closed. For those patients whose underlying lung cannot be expected to reexpand, the procedure of choice is either concomitant removal of the affected lung with the empyema space or obliteration of the pleural space. For patients who are not eligible for the above-mentioned radical treatment, open-window thoracostomy can be considered. This procedure is not only performed as a definitive treatment of empyema but also as a preparatory treatment for radical procedures. Radical procedures are performed when patients recuperate. Choosing the most suitable operation based on the stages of empyema, the conditions of the underlying lung, and the conditions of a patient holds the key to success.

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“…Thoracoplasty ("collapse therapy") represents a partial resection of the chest wall in order to control the underlying inflammatory process, was among the first effective chest surgical interventions (32). Nowadays, the aim of this method is to fill the pleural cavity with connective tissue and / or fill the empirical cavity with tissue (omentum, muscle transposition).…”

Section: Toracoplastymentioning

confidence: 99%