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.

Role of Eloesser flap and thoracoplasty in the third millennium.

In the modern era of thoracic surgery, few indications remain for thoracoplasty. Indeed, many surgeons believe that the resulting deformity outweighs the usefulness of collapse therapy. Rather than trying to obliterate chronic spaces, these surgeons advocate myoplasty techniques to fill the space. Unfortunately, these techniques are not minor procedures and two to three operations are often necessary to solve the problem. This is the reason why thoracoplasty remains the best option in selected patients. In some cases, it should be a first-line procedure rather than as a last resort when everything else has failed. In their discussion of the article by Horrigan and Snow [31], Pairolero and Trastek [44] summarized well the current attitudes toward these different concepts: "Although management of the chronically infected pleural space has changed over the years, the goals of therapy remain the same to conserve the patient's life with a healed chest wall without evidence of infection. Determination of which techniques are necessary to achieve these goals must be tailored to the individual patients."

[Thoracoplasty: the current role]. / La toracoplastica: il ruolo attuale.

The Authors report a retrospective analysis of 29 patients who underwent thoracoplasty between 1990 and 1999. The mean follow-up period was 30 months. The median age was 55 years. The peri-operative mortality rate was 6.8%. The control of space obliteration, space infection and closure of the bronchopleural fistula was achieved in 27 patients. This article also discusses surgical history of thoracoplasty, technique adopted and its current application.

The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition.

This article discusses the surgical history of empyema, thoracoplasty, the Eloesser flap, and muscle flap transfer. Little has changed in the 2000 years since the treatment of empyema was originally described by Hippocrates. The basic concepts of drainage of the infected empyema and obliteration of the space by allowing the lung to come up to the chest wall, taking the chest wall down to the lung, or by using muscle flaps or antibiotic solution remain the stabilizing forces in the treatment of postresection or postinfectious empyemas.

History of surgery for emphysema.

Throughout the 20th century, several operations have been advocated as methods of treatment for patients with emphysema and, often, they were promoted as offering potential cures. Unfortunately, most of these procedures attempted to treat the wrong physiological or anatomic deficit so that mid- or long-term results were unpredictable or frankly disastrous. Procedures such as costochondrectomy were designed to permit further enlargement of the lungs, whereas thoracoplasty was designed to reduce lung volume. Operations were performed to restore the curvature of the diaphragm or devised to increase blood supply to the lung. Almost every thoracic structure including chest wall, diaphragm, pleura, nerves, airways, lung, or esophagus became "at risk" for surgical intervention. Short of bullectomy for emphysematous bullous lung disease and perhaps volume reduction for diffuse emphysema, none of these procedures has stood the test of time.

[Our surgical heritage. Thoracoplasty--discussion of a painting]. / Das chirurgische Erbe. Thorakoplastik--eine Bildbesprechung.

The author reports on a hitherto unknown painting of the South-German artist Hermann Otto Hoyer, representing 'Geheimrat' Ferdinand Sauerbruch surrounded by his coworkers Rudolf Nissen, Alfred Brunner, Emil-Karl Frey, Bernhard Jehn and Willi Felix in Munich 1922.

[Prognosis and treatment of tuberculosis in the pre-chemotherapeutical era]. / Die Prognose und Behandlung der Tuberkulose in der vorchemotherapeutischen Ara.

After discovery of the agent, treatment of tuberculosis was carried out in a variety of ways, the main forms of approach including: 1. Direct action on the bacterium-failed. 2. Influencing the organism by rest and irradiation therapy. 3. Surgical intervention for cavity destruction. 4. Improvement of social conditions. Before surgical intervention was practiced on a large scale prospects for bacteria-excreting patients were very poor, two thirds of them dying within the first 3 years. Where de-bacillization was successful, more than 75 per cent of patients survived 10 years. Nevertheless, none of the forms of treatment had any decisive influence on the tuberculosis situation as a whole.