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World Journal of Clinical Cases Sep 2021Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates. Although there are a wide variety of treatment...
BACKGROUND
Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates. Although there are a wide variety of treatment options, successful management remains challenging when this condition is combined with a large cavity in very thin patients who had previously undergone a posterolateral thoracotomy.
CASE SUMMARY
We reported the case of a thin, 63-year-old man with a progressive pulmonary cyst who underwent left pneumonectomy posterolateral thoracotomy 23 years ago. After an initially uneventful postoperative course, he was readmitted with empyema and a large cavity 21 years after surgery. He was successfully treated with limited thoracoplasty, followed by free vastus lateralis musculocutaneous flap transposition.
CONCLUSION
This case highlights that the treatment mode of limited thoracoplasty and free vastus lateralis musculocutaneous flap transposition is safe and effective for the management of postpneumonectomy empyema with a large cavity in thin patients who had previously undergone a posterolateral thoracotomy.
PubMed: 34621869
DOI: 10.12998/wjcc.v9.i27.8114 -
Journal of Cardiothoracic Surgery Nov 2017Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be... (Review)
Review
BACKGROUND
Deep sternal wound complications are uncommon after cardiac surgery. They comprise sternal dehiscence, deep sternal wound infections and mediastinitis, which will be treated as varying expressions of a singular pathology for reasons explained in the text.
METHODOLOGY AND REVIEW
This article reviews the definition, prevalence, risk factors, prevention, diagnosis, microbiology and management of deep sternal wound infections and mediastinitis after cardiac surgery. The role of negative pressure wound therapy and initial and delayed surgical management is discussed with special emphasis on plastic techniques with muscle and omental flaps. Recent advances in reconstructive surgery are presented.
CONCLUSIONS
Deep sternal wound complications no longer spell debilitating morbidity and high mortality. Better understanding of risk factors that predispose to deep sternal wound complications and general improvement in theatre protocols for asepsis have dramatically reduced the incidence of deep sternal wound complications. Negative pressure wound therapy and appropriately timed and staged muscle or omental flap reconstruction have transformed the outcomes once these complications occur.
Topics: Cardiac Surgical Procedures; Humans; Mediastinitis; Sternotomy; Sternum; Surgical Flaps; Surgical Wound Infection; Thoracoplasty
PubMed: 29096673
DOI: 10.1186/s13019-017-0656-7 -
Journal of Thoracic Disease Nov 2016Extensive chest wall resection and reconstruction is a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeons, plastic... (Review)
Review
Extensive chest wall resection and reconstruction is a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons, and radiation oncologists. The primary goals of any chest wall reconstruction is to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanics, protect intrathoracic organs, provide soft tissue coverage, minimize deformity, and allow patients to receive adjuvant radiotherapy. Successful chest wall reconstruction requires the re-establishment of skeletal stability to prevent chest wall hernias, avoids thoracoplasty-like contraction of the operated side, protects underlying viscera, and maintain a cosmetically-acceptable appearance. After skeletal stability is established, full tissue coverage can be achieved using direct closure, skin grafts, local advancement flaps, pedicled myocutaneous flaps, or free flaps. This review examines the indications for chest wall reconstruction and describes techniques for establishment of chest wall rigidity and soft tissue coverage.
PubMed: 27942408
DOI: 10.21037/jtd.2016.11.07 -
Journal of Thoracic Disease Aug 2016Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open... (Review)
Review
Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases-first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest. Esophageal surgery began its early attempts during the post-World War II era at the Philippine General Hospital (PGH), a university hospital affiliated with the University of the Philippines. With the introduction of minimally invasive thoracic surgical approaches, Filipino thoracic surgeons have managed to keep up with their Asian counterparts although the problems of financial reimbursement typical of a developing country remain. The need for creative innovative approaches of a focused multidisciplinary team will advance the boundaries of thoracic surgery in the Philippines.
PubMed: 27651936
DOI: 10.21037/jtd.2016.06.56 -
The Journal of Cardiothoracic Trauma 2019Operative treatment of rib fractures in the context of flail chest and respiratory failure is a well-established approach. In-line rib osteosynthesis with plates is the...
Operative treatment of rib fractures in the context of flail chest and respiratory failure is a well-established approach. In-line rib osteosynthesis with plates is the standard treatment sufficient to eliminate flail, achieve sufficient stability, and create chest rigidity to improve the respiratory cycle and maintain reduction. However, bridging large skeletal defects with missing portion of ribs is very challenging, particularly in the absence of suitable anchoring rib fragments. We describe an unusual use of vertical plate rib osteosynthesis in a patient with traumatic flail chest, exacerbated by a prior thoracoplasty and severe osteoporosis.
PubMed: 32318653
DOI: 10.4103/jctt.jctt_10_19 -
Global Spine Journal Apr 2023Systematic review and meta-analysis. (Review)
Review
What Are the Effects of Posterior Corrective Surgery, With or Without Thoracoplasty, on Pulmonary Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
This study's objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP).
METHODS
A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I ("Risk Of Bias In Non-randomised Studies - of Interventions") tool. Mean change scores were depicted using forest plots.
RESULTS
Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC.
CONCLUSIONS
PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.
PubMed: 36377069
DOI: 10.1177/21925682221133750 -
BMC Surgery Dec 2019In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate...
BACKGROUND
In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials.
METHODS
A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation.
RESULTS
Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up.
CONCLUSION
Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
Topics: Adult; Aged; Female; Hemoptysis; Humans; Length of Stay; Lung; Male; Middle Aged; Prospective Studies; Pulmonary Aspergillosis; Thoracoplasty; Treatment Outcome
PubMed: 31805919
DOI: 10.1186/s12893-019-0650-1 -
Journal of Children's Orthopaedics Feb 2013Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and... (Review)
Review
Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.
PubMed: 24432061
DOI: 10.1007/s11832-012-0467-2 -
Canadian Medical Association Journal Dec 1966The Clagett method of managing postpneumonectomy empyema was used on two patients and proved efficacious. After tube drainage (if a bronchopleural fistula is present),...
The Clagett method of managing postpneumonectomy empyema was used on two patients and proved efficacious. After tube drainage (if a bronchopleural fistula is present), treatment is begun by creating a pleurostomy in a dependent site. The patient may then be cared for as an outpatient, and dressings may be changed at home. After a few months, when the pleura is clean, the pleurostomy is closed surgically and the space is filled with (1/4)% neomycin solution. If a fistula is present, this is closed at the same time. The treatment depends on the ability of the neomycin to sterilize any residual infection, after temporary drainage of the empyema. It makes unnecessary a major and mutilating thoracoplasty or even permanent tube drainage, which is usually difficult to manage on an outpatient basis.
Topics: Aged; Drainage; Empyema; Humans; Male; Middle Aged; Neomycin; Pneumonectomy; Postoperative Complications; Radiography, Thoracic
PubMed: 5928526
DOI: No ID Found -
Cirugia Y Cirujanos 2023The aim of the study was to present our experience with the vertical musculocutaneous trapezius (VMCT) flap and highlight its utility in the thoracic wall reconstruction...
OBJECTIVE
The aim of the study was to present our experience with the vertical musculocutaneous trapezius (VMCT) flap and highlight its utility in the thoracic wall reconstruction in patients with bronchopleural fistula (BPF).
MATERIALS AND METHODS
We present a five case series of patients with long-standing cavities and BPF. The VMCT flap was used, and a direct pathway into the defect was made through a separate posterior thoracotomy shortening the distance between the flap and the defect.
RESULTS
In 80% of the cases, the flap succeeded in solving the fistula and filling the defect, quality of life improved, and the need for oxygen decreased.
CONCLUSIONS
Management of open window thoracostomy is challenging. Debridement, thoracoplasty, and flap coverage are the mainstream of their treatment, but these patients have scarce available muscle. The VMCT flap represents the major non-affected musculocutaneous unit in the thoracic area after lung surgery. Its dermal component offers a rigid matrix to form a seal over the bronchial stump. Its muscular component adds a good amount of vascularized tissue. No functional impairment has been described after its use.
Topics: Humans; Empyema, Pleural; Quality of Life; Superficial Back Muscles; Surgical Flaps; Pleural Diseases; Bronchial Fistula; Pneumonectomy
PubMed: 37844885
DOI: 10.24875/CIRU.22000210