This study investigates the use of a personal procedure of thoraco-mediastinal-plication in treatment of post-pneumonectomy empyema.
The procedure consists of thoracotomy above the empyema cavity, topographical bone removal of its wall preserving the first rib, incision of the pachypleura following a central vertical line, creation of parietal pachypleura flaps in front of the bronchial fistula by ladder-like incisions through the bed of resected ribs respecting the blood supply and innervation, scraping and repeated lavages of the empyema pouch, suture of the bronchial fistulas (4 different personal techniques), creation of a closed-circuit irrigation-aspiration system using two drains, closure of muscular planes and of the skin in a single layer. The “padding” of the parietal and visceral pleura is completely replaced by external fixation in order to avoid any foreign material; the subscapulary space is not drained. During the last years we also used plombage with muscular flaps from the neighbourhood of the cavity.
The procedure has been used in 26 patients with empyema after pneumonectomy. In 3 patients we performed one-stage pneumonectomy + thoraco-mediastinal plication. We had a 7,7 postoperative mortality (2 patients) and 2 small residual cavities solved by a modified open-window procedure. Most patients required an average 3 weeks of post-operative hospitalisation, with no need of further care after discharge.
We believe that this procedure has certain advantages, as it is safe and ensures a quick healing, which we consider very important in patients with pmeumonectomy for lung cancer. Compared with other types of thoracoplasty/thoraco-mediastinal plication is safer, faster and less mutilant.
We present a surgical solution for a very difficult and challenging problem of modern thoracic surgery.
A.M. Botianu, None.