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The Thoracic and Cardiovascular Surgeon Jun 2020Thoracoplasty was invented for removing cavities between thoracic wall and remnant lung or mediastinum. It was initially used in cases of tuberculosis or unspecific... (Review)
Review
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.
Topics: History, 20th Century; History, 21st Century; Humans; Postoperative Complications; Risk Factors; Thoracoplasty; Treatment Outcome
PubMed: 29772585
DOI: 10.1055/s-0038-1642633 -
Chest Surgery Clinics of North America Aug 1994Langston and Sampson point out that the sine qua non of empyema management is early, adequate, and dependent drainage. Diagnostic thoracentesis followed by closed tube... (Review)
Review
Langston and Sampson point out that the sine qua non of empyema management is early, adequate, and dependent drainage. Diagnostic thoracentesis followed by closed tube thoracostomy and conversion to open drainage, either by a large-bore tube or a rib-resection with a pleurocutaneous fistula, are initial procedures that may be continued for an extended period to control infection, obliterate loculations, and heal co-apted pleural surfaces secondarily. Clagett and Geraci have noted that postpneumonectomy empyema spaces can be "sterilized" and the initial drainage site can be closed after antibiotic instillation. Miller, however, reports success rates for this procedure only in the range of 25% to 33%. Our results are somewhat higher. Obliteration of the persistent space after control of infection by drainage can be accomplished by interposition of muscle flaps with closure of any bronchopleural fistulas and/or by thoracoplasty. As stated previously, myoplastic techniques to obliterate empyemas and close bronchial fistulas in tuberculous disease have a success rate of approximately 75%. Such techniques, however, not only assist in limiting the extent of thoracoplasty, but also may avoid the procedure entirely in some cases. Virkkula has emphasized that use of pedicled myoplasty does not necessarily obviate the need for thoracoplasty. Pairolero and colleagues reported that the use of selected thoracoplasty combined with muscle transposition afforded a 73% success rate for postpneumonectomy empyema and a 64% success rate for closure of persistent bronchopleural fistulas and precludes protracted drainage and/or extended thoracoplasty. Young and Ungerleider concluded that (1) thoracoplasty is more successful if it is applied for patients with parapneumonic rather than postresectional empyemas; (2) concomitant tailoring thoracoplasty has a higher rate of failure; (3) preliminary drainage followed by thoracoplasty has a higher success rate in eliminating the empyema than thoracoplasty alone; (4) first rib resection is indicated for apical collapse only; (5) preoperative preparation is important to control and manage underlying suppurative processes; and (6) thoracoplasty of any type should not be used as a desperation modality of therapy in which uncontrolled sepsis and inadequate drainage are present or in which cancer or unidentified sites of hemorrhage exist. Sequential management of the residual infected space can proceed along several pathways. Many patients with empyema are well-controlled with simple open drainage and with underlying lung reexpansion, either spontaneously or in association with decortication, and may never need thoracoplasty. Drainage and thoracoplasty alone may be effective not only in obliterating an empyema space but also in sealing a bronchopleural fistula.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Empyema, Pleural; Empyema, Tuberculous; Humans; Mediastinum; Muscles; Surgical Flaps; Thoracoplasty
PubMed: 7953486
DOI: No ID Found -
Thoracic Surgery Clinics May 2017A new modification of osteoplastic collapse thoracoplasty performed with a minimally invasive approach has been proposed. This operation is a variant of extrapleural... (Review)
Review
A new modification of osteoplastic collapse thoracoplasty performed with a minimally invasive approach has been proposed. This operation is a variant of extrapleural thoracoplasty used in the treatment of destructive tuberculosis. The benefits of the proposed method, the surgical techniques, and the results of the authors' research are described. Compared with the conventional variant of osteoplastic thoracoplasty, the rates of bacteriologic conversion (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.72-1.97) and of the closure of cavities (OR, 2.13; 95% CI, 1.98-2.28) have been proved to be higher when the operation is performed with a minimally invasive approach.
Topics: Adult; Contraindications; Humans; Male; Minimally Invasive Surgical Procedures; Postoperative Complications; Thoracoplasty; Tuberculosis, Pulmonary
PubMed: 28363378
DOI: 10.1016/j.thorsurg.2017.01.003 -
European Spine Journal : Official... Nov 2022Thoracoplasty is a procedure which involves rib resection from the costovertebral junction to the apex of the rib hump deformity to address the cosmetic concerns of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Thoracoplasty is a procedure which involves rib resection from the costovertebral junction to the apex of the rib hump deformity to address the cosmetic concerns of patients of scoliosis. There is conflicting literature on its effect on pulmonary function. The present meta-analysis was conducted to review and analyze the available literature and ascertain the effect of thoracoplasty on pulmonary function.
METHODS
Search was conducted according to PRISMA guidelines on three databases. After analysis of all the search results by title, abstracts and full texts-10 studies were identified for inclusion in the review. We included studies which had analyzed preoperative and postoperative pulmonary function tests (PFTs) after thoracoplasty. Pooled estimates were calculated for pulmonary function, and effect of other factors was analyzed by subgroup analysis and meta-regression.
RESULTS
The included studies were published between 1998 and 2019. A total of 385 patients were included in these studies, with a mean age of 15.01 years, with a female preponderance. Apprehension over appearance of rib hump was the most common indication for thoracoplasty. Percent-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV-1) were significantly decreased on follow-up. Anterior approach to corrective surgery and lower age were found to be associated with worse pulmonary function. Preoperative Cobb's angle was found to have significant impact on decrease in FEV-1 only, but not on other PFT parameters.
CONCLUSION
Overall decrease in pulmonary function after thoracoplasty necessitates the need of adequate preoperative pulmonary function to mitigate its effect on patient well-being. Use of a posterior approach for corrective surgery when thoracoplasty is planned might lead to better outcomes. More research is needed to study effect of preoperative Cobb's angle on pulmonary function.
Topics: Humans; Adolescent; Female; Thoracoplasty; Scoliosis; Kyphosis; Vital Capacity; Lung
PubMed: 36069937
DOI: 10.1007/s00586-022-07375-9 -
Asian Cardiovascular & Thoracic Annals Jul 2021Management of residual pleural space remains a challenge in the practice of thoracic surgery. Options include thoracotomy with muscle flap/wound vac, Eloesser procedure,...
BACKGROUND
Management of residual pleural space remains a challenge in the practice of thoracic surgery. Options include thoracotomy with muscle flap/wound vac, Eloesser procedure, or thoracoplasty. We examine current practice and short-term outcomes of thoracoplasty in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP).
METHODS
A retrospective review of thoracoplasty procedures (by CPT® code 32900, 32905, or 32906) in the ACS NSQIP database from the years 2012 to 2017 was performed. The ACS NSQIP prospectively collects perioperative and rigorous 30-day outcome data for patients undergoing major thoracic surgical nationally.
RESULTS
The dataset contained 131 thoracoplasties in patients with an average age of 48 years (SD 19), average BMI of 26 kg/m (SD 5), 48% female, and 21% of minority race. Forty percent of patients were ASA class III and 10% class IV-V. Five percent of the patients had muscle flap in addition to thoracoplasty. Median operative duration was 101 min (interquartile range 61-167) and 8% of patients required blood transfusion. The average length of hospital stay was 6 days (SD 9), and 93% of patients were discharged home. There was one death, and 23% experienced other major morbidity. Thirty-day readmission occurred in 8% of patients and 6% returned to the operating room within 30 days. Four percent of patients experienced respiratory failure, 4% sepsis, and 5% developed pneumonia.
CONCLUSIONS
Short-term outcomes of current thoracoplasty demonstrate low mortality and morbidity. Thoracoplasty should remain in our armamentarium for managing residual pleural space.
Topics: Female; Humans; Length of Stay; Male; Middle Aged; Patient Readmission; Postoperative Complications; Retrospective Studies; Risk Factors; Thoracoplasty
PubMed: 33709802
DOI: 10.1177/02184923211002408 -
Journal of Pediatric Surgery Aug 2005In our case report and literature review, we report about a female newborn with severe asphyxiating thoracic dysplasia of the spondylocostal dysostosis classification to... (Review)
Review
In our case report and literature review, we report about a female newborn with severe asphyxiating thoracic dysplasia of the spondylocostal dysostosis classification to whom an expandable thoracoplasty with metal implants offered survival and discharge at home from newborn to infancy.
Topics: Asphyxia Neonatorum; Female; Humans; Infant, Newborn; Musculoskeletal Abnormalities; Pneumonia; Reoperation; Respiration, Artificial; Thoracoplasty; Thorax; Tracheostomy
PubMed: 16080946
DOI: 10.1016/j.jpedsurg.2005.05.033 -
Edinburgh Medical Journal Mar 1949
Topics: Thoracoplasty; Thorax
PubMed: 18144519
DOI: No ID Found -
Thorax Mar 1955
Topics: Collapse Therapy; Plastic Surgery Procedures; Thoracoplasty
PubMed: 14373654
DOI: 10.1136/thx.10.1.1 -
Spine Deformity Jan 2021Retrospective review of prospective multi-center cohort.
STUDY DESIGN
Retrospective review of prospective multi-center cohort.
OBJECTIVE
To investigate the impact of thoracoplasty on pulmonary function at 2-year follow-up among complex pediatric spine deformity patients. Complex pediatric spine deformities may be associated with significant rib prominence causing body image concerns. Surgical correction of spine deformity may include thoracoplasty to correct the rotational prominence. Some surgeons refrain from performing thoracoplasty due to its purported negative effect on pulmonary function. There is paucity of literature on the effect of thoracoplasty on pulmonary function at 2-year follow-up in pediatric patients with complex spine deformity.
METHODS
We reviewed data of 312 patients (> 100°, with or without vertebral column resection (VCR)) or (< 100° with VCR)) from an international multicenter database. Data of 106 patients with complete radiographic and pulmonary function test (PFT) assessment with a minimum of 2-year follow-up was analyzed. Paired t test was performed to compare pre-op and 2-year PFT results. PFT comparison was stratified based on thoracoplasty status (thoracoplasty: Group 1 vs. no thoracoplasty: Group 2).
RESULTS
106 patients (61 patients Group 1 vs. 45 in Group 2). The average age and gender ratio were similar in both groups (p > 0.05). Group 1 had significantly lower body mass index (BMI) compared to Group 2 (18.4 kg m ± 2.8 vs. 19.9 kg m ± 4.8, p = 0.0351). The average baseline coronal and sagittal Cobbs were larger for Group 1 relative to Group 2 (p < 0.05). The distribution of deformity etiology and curve types, and apices were similar between the two groups (p > 0.05). The rate of pre-op utilization of halo gravity traction (HGT) was 52.5% vs. 26.7% (p = 0.008), at an average duration of 103 days vs. 47 days, p = 0.0001. The rate of surgical osteotomies was similar in both groups. Estimated blood volume (EBV) loss was greater in Group 1 (63.1% vs. 43.1%, p = 0.0012). Post-op coronal and sagittal Cobb correction was similar in both groups. The incidence of post-op pulmonary complication was similar in both groups (8.2% vs. 8.9%, p = 0.899). Baseline and 2-year follow-up PFT did not differ significantly between and within the groups. Vertebral column resection (VCR) did not negatively affect PFT in both groups.
CONCLUSION
Despite higher curve magnitudes in patients undergoing surgical correction and thoracoplasty for complex pediatric spine deformity, our findings revealed that thoracoplasty does not negatively affect pulmonary function at 2-year follow-up.
Topics: Child; Follow-Up Studies; Humans; Lung; Prospective Studies; Retrospective Studies; Scoliosis; Thoracoplasty
PubMed: 32812164
DOI: 10.1007/s43390-020-00188-0 -
The Annals of Thoracic Surgery Feb 2016
Topics: Female; Humans; Male; Prostheses and Implants; Thoracic Diseases; Thoracic Wall; Thoracoplasty; Titanium
PubMed: 26777962
DOI: 10.1016/j.athoracsur.2015.10.009