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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 -
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 -
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 -
Medicine Sep 2020Razor back deformity is one of the most noticeable problems of severe scoliosis. Thoracoplasty has been reported to be a useful approach to correct the rib hump...
Effectiveness and safety of a modified (rib ends fixed under transverse process) thoracoplasty for rib hump deformity in adults with severe thoracic scoliosis: A retrospective study.
Razor back deformity is one of the most noticeable problems of severe scoliosis. Thoracoplasty has been reported to be a useful approach to correct the rib hump deformity. However, the outcomes of thoracoplasty in patients with severe, rigid, thoracic scoliosis have not yet been evaluated.To evaluate the effectiveness and safety of a modified technique of thoracoplasty (rib ends fixed under transverse process) for rib hump deformity in adults with severe thoracic scoliosis and severe pulmonary dysfunction.Patients with severe thoracic scoliosis and severe pulmonary dysfunction who underwent staged surgical strategy including halo-pelvic traction, spinal osteotomy combined with the modified thoracoplasty were included. To avoid paradoxical breathing result from multiple rib resections and enlarge the capacity of thoracis, the ends after rib resection were fixed under transverse process compared with conventional thoracoplasty. Patients were excluded on the basis of pulmonary diseases and inadequate follow-up. Data on deformity correction and pulmonary complications were reviewed. A t test was performed on the pre- and postoperative data of pulmonary function, height of the rib hump deformity, and total lung area.Eighteen patients (5 men and 13 women) with a major thoracic curve of >130° were included. The mean age of patients was 25.3 ± 3.6 years (range, 19-32 years), with an average length of follow-up of 30.2 months. After application of halo-pelvic traction, the mean major thoracic curve decreased from 168.2° ± 14.28° to 97.3° ± 10.75° and the thoracic kyphosis decreased from 159.4° ± 20.60° to 94.8° ± 9.58°. On average, 6.3 (range, 4-8) ribs were resected. The height of the rib hump decreased from 84.6 ± 13.3 to 15.3 ± 3.4 mm. The average predicted forced vital capacity (FVC%) before surgery was 37.2 ± 13.30%, indicative of severe pulmonary impairment, with a small but non-significant improvement in the FVC% at the final follow-up. The mean total lung area increased from 2583.2 ± 501.36 to 2890.1 ± 537.30 mL at the last follow-up. No severe pulmonary complications occurred.Our modified approach to thoracoplasty procedure is effective and safe in correcting a razor back deformity in patients with severe, rigid, scoliosis, and severe pulmonary dysfunction, without causing any significant change in long-term pulmonary function.
Topics: Adult; Female; Humans; Male; Radiography; Retrospective Studies; Scoliosis; Thoracoplasty; Young Adult
PubMed: 32991478
DOI: 10.1097/MD.0000000000022426 -
The European Respiratory Journal Aug 2002Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is... (Review)
Review
Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis). If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative. There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that "prophylactic" ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease. There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is approximately 90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.
Topics: Humans; Neuromuscular Diseases; Outcome Assessment, Health Care; Respiration, Artificial; Survival Rate; Thoracic Diseases; Thoracic Wall
PubMed: 12212984
DOI: 10.1183/09031936.02.00404002 -
California Medicine Mar 1949Those physicians who deal with children have much to contribute toward case finding in tuberculosis among these patients as well as adults. The tuberculin test is the...
Those physicians who deal with children have much to contribute toward case finding in tuberculosis among these patients as well as adults. The tuberculin test is the most accurate weapon at hand. Contacts other than the parents should be looked for. Symptoms, beside fever, to be noted are eye and skin complaints. In the physical examination the chest is relatively unimportant as compared to the eye, the skin, the lymphatic and skeletal systems. In the roentgenographic examination, epituberculosis and atelectasis should be differentiated. When stomach washings are necessary for the diagnosis, the tuberculin test on the guinea-pig should not be forgotten. Careful laboratory studies will clear up roentgenographic confusion. In the treatment, removal of contact is essential, and often all that is necessary, but other factors should be considered. Of the more common complications, atelectasis, bronchiectasis, and cavitation or reinfection, may be treated surgically with all the accepted methods except thoracoplasty. Heliotherapy should not be forgotten in bone and joint tuberculosis. It is to be hoped that BCG will prove efficacious in vaccination, but published reports are not scientifically convincing. It destroys the value of the tuberculin test where used, and it should never be substituted for removal of contact as a prophylactic measure.
Topics: Adult; Bronchiectasis; Child; Female; Fever; Guinea Pigs; Heliotherapy; Humans; Infant; Male; Parents; Skin; Thoracoplasty; Thorax; Tuberculin Test; Tuberculosis; Tuberculosis, Osteoarticular; Vaccination
PubMed: 18124246
DOI: No ID Found -
European Spine Journal : Official... Jun 2003Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are,...
Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.
Topics: Adolescent; Anthropometry; Female; Humans; Image Processing, Computer-Assisted; Male; Predictive Value of Tests; Ribs; Rotation; Scoliosis; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 12800002
DOI: 10.1007/s00586-002-0523-6 -
Asian Journal of Surgery Jul 2018Empyema thoracis (ET) is one of the common thoracic diseases frequently found in developing countries. In the past, only a few studies have analyzed recurrent ET, and...
BACKGROUND
Empyema thoracis (ET) is one of the common thoracic diseases frequently found in developing countries. In the past, only a few studies have analyzed recurrent ET, and none had clearly identified the prognostic factors for recurrence. The aim of this study is to identify the prognostic factors of recurrent ET in Northern Thailand.
METHODS
A retrospective cohort study was conducted. All patients diagnosed with Stage II and III ET at Maharaj Nakorn Chiang Mai Hospital (a tertiary-care hospital in northern Thailand) between January 1, 2007 and November 31, 2012 were enrolled in this study. All clinical data were extracted from the medical recording system. The primary outcome was recurrent disease. Multivariable Cox's proportion hazard model was used to identify the independent prognostic factors for recurrence.
RESULTS
There were 382 patients enrolled in this study, and 34 patients (8.9%) had recurrent disease. The most common gram-positive and gram-negative pathogens found were Staphylococcus aureus and Acinetobacter baumannii, respectively. Three independent prognostic factors for recurrent disease were nonsepsis status prior to the surgery [hazard ratio (HR) = 12.3; 95% confidence interval (CI), 4.25-35.43], nonperforming decortication (HR = 5.4; 95% CI, 1.82-15.92), and persistent pleural spaces (HR = 4.1; 95% CI, 1.93-8.68).
CONCLUSIONS
Clinical characteristics, surgical procedure, and persistent pleural spaces were independent prognostic factors for ET recurrence in this study. Decortication and early thoracoplasty in patients who had persistent pleural space should be considered. Large cohort studies are warranted to support these findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Empyema, Pleural; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Proportional Hazards Models; Recurrence; Retrospective Studies; Risk Factors; Thailand; Young Adult
PubMed: 28372933
DOI: 10.1016/j.asjsur.2017.02.009 -
Spine Surgery and Related Research 2019The purpose of this study is to investigate thoracic deformity correction and pulmonary function changes in patients with adolescent idiopathic scoliosis (AIS) five...
Thoracic Deformity Correction and Changes of Vital Capacity, Forced Expiratory Volume in 1 Second, and Expiratory Flow in Adolescent Idiopathic Scoliosis Five Years or More after Posterior Spinal Fusion with Thoracoplasty.
INTRODUCTION
The purpose of this study is to investigate thoracic deformity correction and pulmonary function changes in patients with adolescent idiopathic scoliosis (AIS) five years or more after undergoing posterior spinal fusion with thoracoplasty for correction of a thoracic deformity.
METHODS
Subjects were 57 patients with AIS who underwent posterior spinal fusion between 2004 and 2010. 24 patients who had undergone thoracoplasty at least five years earlier agreed to participate in this research. X-rays, pulmonary function tests, and thoracic cage computed tomography (CT) were performed, and the Scoliosis Research Society Outcomes Questionnaire (SRS-22) was administered. CT axial images were used at the apex of the main thoracic (MT) curve. Apical vertebral rotation was evaluated using rotation angle to the sagittal plane (RA). Thoracic deformities were evaluated using the rib hump index (RHi) and the posterior hemithoracic symmetry ratio (PHSr).
RESULTS
There were no significant differences between the preoperative and the final observation forced vital capacity (FVC) or the preoperative and the final observation %FVC. The forced expiratory volume in 1 s (FEV1) and %FEV1 were significantly improved at the final observation: FEV1 (preoperative: 1.88 L, final observation: 2.05 L, = 0.045) and %FEV1 (preoperative: 57.1%, final observation: 66.2%, = 0.001). FEV1/FVC was also significantly improved at the final observation (preoperative: 83.0%, final observation: 86.4%, = 0.019). The peak expiratory flow (PEF) was significantly improved at the final observation (preoperative: 3.67 L/s, final observation: 4.38 L/s, = 0.029). On the CT assessment for thoracic deformities, there were no significant changes in RA or RHi. PHSr was significantly increased at the final observation compared with the preoperative period.
CONCLUSIONS
With posterior spinal fusion in combination with thoracoplasty for AIS, although the correction of deformities was limited, the pulmonary function testing demonstrated the preservation of vital capacity (VC) and improvements in the forced expiratory volume in 1 s and expiratory flow.
PubMed: 31440680
DOI: 10.22603/ssrr.2018-0075