We report the rare case of a 58-year-old woman who was diagnosed with fungal empyema thoracis combined with osteoradionecrosis. After 32 months of home care followed by open window thoracostomy, thoracoplasty with serratus anterior muscle transposition and a latissimus dorsi myocutaneous flap was performed successfully. Although thoracoplasty is now rarely indicated, it is still the treatment of choice for the complete obliteration of thoracic spaces.
Empyema* ; Female ; Home Care Services ; Humans ; Middle Aged ; Myocutaneous Flap* ; Osteoradionecrosis* ; Superficial Back Muscles ; Thoracoplasty* ; Thoracostomy

OBJECTIVETo study the experiences and operative procedure choice for surgical management of chronic tuberculous empyema.

METHODSTotally 461 patients of chronic tuberculous empyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December 2011. There were 317 male and 144 female patients, aging from 6 to 79 years with a mean age of 32 years. Preoperative duration lasted from 3 months to 50 years, including 347 cases within 1 year, 61 cases 1 to 2 years, and 53 cases above 2 years. Chest tube drainage or pleuracentesis was performed in 395 patients, decortication in 287 patients, thoracoplasty in 13 patients, pleuropneumonectomy and resection of remaining lung in 11 patients, complex operation in 150 patients.

RESULTSThere was no death perioperatively. Four hundred and forty-five patients were cured at once, 6 patients were cured by stages. One patient with empyema and bronchial fistula relapsed bronchial fistula after pulmonary lobectomy and pleural decortication, whom was cured by the combination operation which including fistula repair, muscle flap tamponing and local thoracoplasty according to the closed drainage of thoracic cavity after 6 months. Three cases were suffered incision delayed healing and were cured by dressing change. Five cases were suffered abscess of chest wall within 3 months and were cured by local thoracoplasty. One patient died due to respiratory failure in one year which resulted in tuberculosis spreading because of bronchial fistula after pleuropneumonectomy.

CONCLUSIONSSurgical management of chronic tuberculous empyema still have irreplaceable roles. Selecting appropriate operations according to different cases will achieve good results.

Abscess ; Adolescent ; Adult ; Aged ; Bronchial Fistula ; Chest Tubes ; Child ; Chronic Disease ; Drainage ; Empyema, Tuberculous ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Respiratory Insufficiency ; Surgical Wound Infection ; Thoracic Wall ; Thoracoplasty ; Young Adult

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the last 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.
Chest Pain ; Humans ; Neoplasm Metastasis ; Ovum ; Recurrence ; Ribs ; Sarcoma, Ewing ; Thoracic Wall ; Thoracoplasty ; Thorax

OBJECTIVETo analyze thoracic complications related to the convex thoracoplasty for the treatment of rib hump deformity in patients with thoracic scoliosis.

METHODSBetween December 2003 and September 2007, 548 patients with thoracic scoliosis underwent posterior spinal correction and the convex thoracoplasty. There were 167 male and 381 female, with an average age of 16.1 years (range, 12 to 38 years). The mean preoperative rib prominence was 35 degrees (range, 16 degrees to 50 degrees).

RESULTSThe mean number of resected ribs was 4.1. The mean rib prominence was 7 degrees (range 2 degrees to 17 degrees) after operation. No death happened. Thoracic complications related to the thoracoplasty consisted of respiratory insufficiency in 1 (0.2%) patient,intraoperative tear of parietal pleura in 29 (5.3%), with a subsequent pleural effusion in 6 and pneumothorax in 3. In the other patients, no obvious tear of parietal pleura was found during operation. However, 6 (1.1%) patients had pleural effusion after operati on.

CONCLUSIONThe thoracic complications related to convex thoracoplasty can be decreased by improving the surgical skill and using respiratory function monitoring.

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Thoracic Vertebrae ; surgery ; Thoracoplasty ; adverse effects

BACKGROUND: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. MATERIAL AND METHOD: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean 59.1+/-6.4) and a male preponderance was noted (17:3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. RESULT: The mean duration of the air leaks after thoracoplasty was 1.6+/-0.2 days (range: 0~7 days) and the mean duration of an indwelling chest tube was 7 days (range: 5~11 days); the mean duration of hospitalization was 19.2+/-2.8 days (range: 8~47 days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. CONCLUSION: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.
Bronchiectasis ; Chest Tubes ; Compression Bandages ; Empyema ; Hemorrhage ; Hospitalization ; Humans ; Lung ; Lung Abscess ; Lung Neoplasms ; Male ; Mortality ; Pneumonia ; Pneumothorax ; Postoperative Complications ; Reoperation ; Ribs ; Thoracic Cavity ; Thoracoplasty* ; Thorax ; Tuberculosis, Pulmonary ; Wound Infection

OBJECTIVESTo evaluate the correlation between preoperative pulmonary function tests, surgical approach and postoperative time of tracheal extubation in patients with scoliosis.

METHODSThe case records of 115 patients, who underwent anterior or posterior fusion, were reviewed. And we studied the relative factors on postoperative time of tracheal extubation by multiple linear regression analysis.

RESULTSMultiple linear regression showed that the time of tracheal extubation had negative correlation with the VC%, MVV%, FEV1%, FEF25% and thoracoplasty. On the other hand, the time of extubation in patients with thoracoplasty was larger than those without thoracoplasty, but the time of extubation in patients with or without thoracotomy had no statistical significance.

CONCLUSIONSVC%, MVV%, FEV1%, FEF25% and thoracoplasty are the main determinants of the time of extubation in patients with scoliosis. Preoperative pulmonary function evaluation and surgical approach selection may play an important role in determining the time of tracheal extubation in patients with scoliosis.

Adolescent ; Adult ; Child ; Female ; Humans ; Intubation, Intratracheal ; Lung ; physiopathology ; Male ; Postoperative Period ; Respiratory Function Tests ; Retrospective Studies ; Scoliosis ; physiopathology ; surgery ; Thoracoplasty ; Thoracotomy ; Time Factors

BACKGROUND: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. MATERIAL AND METHOD: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: 45.9+/-9 years). The patients were followed up for a mean of 58 months (median: 28 months, range: 6~169). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema. RESULT: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). CONCLUSION: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to TB-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.
Empyema* ; Female ; Fistula ; Follow-Up Studies ; Hepatitis ; Humans ; Lung ; Male ; Mortality ; Pneumonectomy ; Recurrence ; Sepsis ; Surgical Flaps* ; Thoracoplasty*

BACKGROUND: Chest wall deformities such as kyphoscoliosis, thoracoplasty, and fibrothorax cause ventilatory insufficiency that can lead to chronic respiratory failure, with recurrent fatal acute respiratory failure(ARF). This study evaluated the frequency and outcome of ARF, the physiologic status, and the long-term prognosis of these patients. METHODS: Twenty-nine patients with chest wall disorders, who experienced the first requirement of ventilatory support from ARF were examined. The mortality and recurrence rate of ARF, the pulmonary functions with arterial blood gas analysis, the efficacy of home oxygen therapy, and the long-term survival rate were investigated. RESULTS: 1) The mortality of the first ARF was 24.1%. ARF recurred more than once in 72.7% of the remaining 22 patients, and overall rate of successful weaning was 73.2%. 2) Twenty-two patients who recovered from the first ARF showed a restrictive ventilatory impairment with a mean FVC and TLC of 37.2% and 62.4 % of predicted value, respectively, and a mean PaCO2 of 57mmHg. Among the parameters of pulmonaty functions. the FVC(p=0.01) and VC(p=0.02) showed a significant correlation with the PaCO2 level. 3) There were no significant differences between the patients treated with conservative medical treatment only and those with additional home oxygen therapy due to significant hypoxemia in the patients with recurrent ARF and the mortality. 4) The 1, 3, 5-year survival rates were 75%, 66%, and 57%, respectively, in the 20 patients who had recovered from the first ARF, excluding the two patients managed by non-invasive nocturnal ventilatory support. CONCLUSION: These results suggest that active ventilatory support should be provided to patients with ARF and chest wall disorders. However, considering recurrent ARF and weak effect of home oxygen therapy, non-invasive domiciliary ventilation is recommended in those patients with these conditions to achieve a better long-term prognosis.
Anoxia ; Blood Gas Analysis ; Congenital Abnormalities ; Humans ; Mortality ; Oxygen ; Prognosis* ; Recurrence ; Respiratory Insufficiency ; Survival Rate ; Thoracic Wall* ; Thoracoplasty ; Thorax* ; Ventilation ; Weaning

OBJECTIVETo investigate the application of a novel degradable biomaterial as a chest wall prosthesis and provide valuable scientific basis for clinical application.

METHODSPreparation of chitin long fiber reinforced polycaprolactone (PCL) by means of melt blending and modeling. Full-thickness chest wall defects of 10 cm x 8 cm was created in 10 dogs and then repaired with long chitin fiber reinforced PCL artificial rib in 8 dogs (tested group) and Marlex mesh in 2 dogs (control group). It was dynamically observed that the situation of the implanted chest wall prosthesis and the progress of the regeneration of the chest wall tissue postoperatively.

RESULTSNo operative and perioperative deaths were observed in all experimental dogs. In tested group, slight paradoxical respiration occurred in 2 dogs and could not be seen in 2 weeks. No chest wall subsidence and infection occurred. New bone tissue obviously regenerated around both resection ends of the ribs and integrated tightly with artificial ribs. In control group, there were evidently paradoxical respiration and chest wall subsidence. Marlex mesh folded and was enveloped by fibrous tissue.

CONCLUSIONDegradable chitin long fiber reinforced PCL can provide effective support to chest walls and is a practicable material for chest wall reconstruction.

Animals ; Biocompatible Materials ; Chitin ; Disease Models, Animal ; Dogs ; Female ; Male ; Polyesters ; Prostheses and Implants ; Prosthesis Implantation ; Reconstructive Surgical Procedures ; methods ; Thoracic Wall ; injuries ; surgery ; Thoracoplasty ; methods

PURPOSE: To evaluate the patterns of preoperative pulmonary function tests(PFTs) and their correlation with postoperative pulmonary impairment in patients with adolescent idiopathic scoliosis(AIS), who had orthopaedic operation with or without rib resection thoracoplasty. METHODS: The case records and radiographs of 79 patients(12, boys and 67, girls) of a mean age of 13.3 years(7-15 years) with AIS who underwent orthopaedic operations at the author's institute between 1997 and 2003 were reviewed. RESULTS: The average preoperative coronal Cobb measurement was 56 (range, 32-81 ). Thirty-one patients(39%) had normal values of of PFTs. Forty five patients(57%) with severe scoliosis(Cobb's angle 65-90 ) showed mild to moderate decrease on PFTs with FVC(73%), FEV1(79%), FEV25-75%(58 %). The severity of Cobb's angle were correlated with the decrease in FVC, FEV1, FEV25-75%(P< 0.05). Forty-three patients had thoracoplasty. Twenty-two(51%) of them had pleural effusions. Eleven patients among them had chest tube inserted postoperatively. But, none of the patients had any increased requirement of postoperative ventilatory support. The incidence of postoperative pulmonary effusion in patients with thoracoplasty was a 17-fold increase, compared to the patients without thoracoplasty(O.R.=17, chi-squared-test, P<0.05). CONCLUSION: The fall in FVC and FEV1 of patients with mild to moderate scoliosis(Cobb's angle, below 65 ) was mild and was unlikely to be of clinical significance. It appeared that patients with severe AIS had mild to moderate restrictive patterns with reduced lung volumes. Performance of the thoracoplasty was the important risk factor for postoperative pulmonary complications in patients underwent surgical operation.
Adolescent* ; Chest Tubes ; Humans ; Incidence ; Lung ; Pleural Effusion ; Reference Values ; Respiratory Function Tests ; Ribs ; Risk Factors ; Scoliosis* ; Thoracoplasty