The Polythene Pack Operation for Pulmonary Tuberculosis

Abstract

Surgical collapse of the lung has won an honoured place in the treatment of pulmonary tuberculosis and, in the form of thoracoplasty, is widely used. We are, however, very conscious of the drawbacks of this operation. No matter what the individual technique or aftercare, in a certain proportion of cases the collapse of the apex of the lung, which had seemed so perfect a week after operation, is found a few weeks later to be less complete, and cavities which had closed to have reopened in the re-expanding lung. The ordeal of multiple stages and the inevitable permanent deformity are, moreover, distasteful to the surgeon and to the patient alike, being acceptable only as a life-saving necessity.In the past, efforts have been made to overcome these defects by the use of plombage. The experience at that time of one of us (Morriston Davies, 1933, 1944 was not encouraging. Paraffin plombs had a tendency to lead to ulceration from surface cavities, or to produce tissue reaction leading to abscess formation necessitating the subsequent extraction of the foreign body. Living tissue grafts of breast and muscle failed because they were difficult to pack into the extrapleural space and, even when the immediate result was good, later shrank. Plombage, with fat from other parts of the body and lipomata, was equally unsatisfactory owing to the tendency to liquefy and disintegrate. Later extrapleural pneumothorax was tried and still has its advocates, as has the substitution of the air in the extrapleural space by oil.Since 1937 Semb has been advocating the extrafascial stripping of the lung from the mediastinum when doing a thoracoplasty. For a time this was hailed by some as a solution of the problem of re-expansion of the lung but not of the deformity. Still later Semb (1950) tried air refills of the " Semb space," and he and others (Edwards, 1949) have attempted many varieties of bone graft and suture to assist in maintaining the collapse of the lung and cavity. The quest for a solution of the two problems, the prevention of re-expansion and of deformity associated with a thoracoplasty, continues.In 1946 Wilson published his paper on the use of polymethyl methacrylate or lucite balls as an extrapleural plomb. This interested us as there was evidence that the balls did not irritate the tissues, and it seemed evident that they could be made to accommodate any size and shape of space. When, however, we obtained samples of these lucite balls we decided against their use. The very hardness and unresilient qualities of lucite, at any rate as spheres, seemed to us to constitute a danger. The insertion of an unyielding substance extrapleurally in apposition to the lung, with p on 11 May 2018 by guest. Protected by copyright.

Basal Plombage

“…Morriston Davies, Temple, and Stathatos (1951) in a series of 101 plomb operations recorded five instances where the operation was used for basal cavities. In no instance was sputum conversion secured.…”

Tracheal compression: a late complication of plombage

“…It was introduced in Britain in the late 1940s when the epidemic spread of tuberculosis combined with a lack of antituberculous drugs led to a vogue for surgical procedures to treat pulmonary tuberculosis before the advent of antituberculous drugs. 1 A 77-year-old woman presented in April 2010 in acute respiratory distress (figure 1). She developed type II respiratory failure and rapidly deteriorated.…”