Thoracoplasty-Current View on Indication and Technique.

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.

Cirurgia de redução do volume pulmonar no efisema: experiência da Klinik Löwenstein - Alemanha / Lung volume reduction surgery: experience of the Klinik Löwenstein - Germany

Os autores apresentam a experiência adquirida no tratamento cirúrgico do efisema severo na Klinik Löwenstein - Alemanha. No período de janeiro de 1993 a dezembro de 1996, setenta e três pacientes efisematosos foram submetidos à cirusrgia de redução do volume pulmonar. Os critérios de indicação cirúrgica foram dispnéia de repouso incapacitante para tarefas cotidianas, parâmetros vintilatórios msotrando hiperinsulflaçào e obstrução significantes, expectativa de vida acima de cinco anos, necessidade de oxigenoterapia e presença de efisema difuso heterôgeneo. Os pacientes foram submetidos a minitoractomia e o parênquima pulmonar foi ressecado com sutura mecênica protegida por tecido de politetrafluoretileno. os pacientes foram seguidos por até dois anos de pós-operatório. Os resultados obtidos demonstram que os pacientes com efisema heterogêneo se beneficiam da cirurgia redutora (melhora dos parâmetros clínicos, ventilatório e gases sangüíneos) e esse benefício é mais evidente em pacientes com doença restrita aos lobos superiores, naqueles submetidos à cirurgiua bilateral e com menos de 70 anos idade (au)