Thoracoplasty—Current View on Indication and Technique

Abstract

Thoracoplasty was invented for removing cavities between thoracic wall and remnant lung or mediastinum. It was initially used in cases of tuberculosis or unspecific infections, while currently it is used mainly for space problems after lobectomy/pneumonectomy.This article presents an overview of the historical and current techniques of this surgical procedure.Nowadays, thoracoplasty is rarely performed due to the low incidence of diseases for which this method is necessary. Therefore, this method has even been discredited. Furthermore, certain technical aspects of the thoracoplasty are not very well known because of the infrequent application of this procedure.Unfortunately, a look into the literature of thoracoplasty is not always usefull due to the biased views of advocates of different techniques such as Schede's thoracoplasty, Heller's Jalousie-Plastik, Alexander's extramusculoperiosteal thoracoplasty, Bjork's osteoplastic thoracoplasty, etc.Not to forget, there has always been a lack of research on the relevance and on the several techniques of thoracoplasty.The point is precise indication and correct execution of thoracoplasty as a final therapeutic option, which allows a safe and definitive solution of the space problem even in complex cases, without creating serious functional and cosmetic impairment for the patient.The main types of thoracoplasty are described in this article. Although the core principle of this operation remains unchanged, modern techniques are often cosmetically more considerable and less destructive, compared with techniques that were used in the past.

Complex chest wall wound managed by a novel technique of thoracoplasty

“…The basic principle to obliterate this space was ‘bring the chest wall to lung if you cannot bring the lung to chest wall’. Although the technique was invaluable in achieving its aim, the marked deformation following surgery was poorly accepted and acted as a deterrent in its popularity 4–6. Over time, the enthusiasm for this technique has dwindled, and reports of thoracoplasty have reduced markedly in the literature.…”

“…Thoracoplasty and its various modifications have been reported primarily for dealing with persistent dead space following pneumonectomy or chronic suppurative lung diseases 5 6 8. To the best of our knowledge, a modified thoracoplasty or thoracomyoplasty procedure has never been used for the management of complex chest wall defects.…”

“…Originally described in late 19th century as a procedure to obliterate the problematic residual pleural space following pneumonectomy and met with an initial enthusiasm, it has become less popular over the years owing primarily to poor cosmetic and functional outcome 4–7. The technique involves mobilisation of a large portion of the chest wall on the affected side anteriorly form the costal cartilages close to the sternum as far as and close to costo-vertebral junction of the ribs posteriorly.…”

Die pleurale Residualhöhle nach Lungenresektion

“…27 % [54]. Trotz der nicht unerheblichen Morbidität sowie der funktionellen und kosmetischen Beeinträchtigungen ist diese Methode in wenigen Fällen der letzte Ausweg, um das persistierende Höhlenproblem bei vorangegangenen ineffektiven Maßnahmen sicher und definitiv zu lösen [55,56]. Einige Autoren favorisieren die Thorakoplastik als primäres Verfahren, um eine Postpneumonektomiehöhle nach erfolgter Thorakostomaanlage zu beseitigen.…”

Radiodiagnosis of Pneumonodular Fistula as a Rare Complication of Tuberculous Mediastinitis in a Teenager with Generalized Tuberculosis

“…Поражение лимфатических узлов средостения не является редкостью. Воспалительный процесс зачастую вовлекает окружающие структуры, что может привести к развитию осложнений туберкулеза, в том числе к формированию свищей [1][2][3][4][5][6][7][8]. Однако частота возникновения фистул при поражении внутригрудных лимфатических узлов невелика, а в мировой литературе подобные случаи представлены ограниченным количеством статей.…”