The Combined Thoracoplasty

¹ Schatzalp Sanatorium, Davos, Switzerland

A) Weak Points of Thoracoplasty: Breathing capacity reduced by paradoxical movements of operated side, paradoxical retractions and expansion of the unsupported thoracic wall, consequently traction irritation of cortical lesions. Difficulties in expectoration, (reasons thereof intensified by painful coughing). Consequences: retention of sputum, increase of lesions and danger of further pulmonary and extrapulmonary spreads.

B) Prevention of these Weak Points: Restriction of thoracoplasty to the posterior-lateral parts of the four to five upper ribs, the region which is covered by the shoulder blade. In this region paradoxical movements are thus avoided, but therapeutic effect is insufficient, therefore accessory factors of collapse therapy are necessary.

C) The Combined Collapse Method:

1) Resection of the posterior-lateral parts of the four to five upper ribs and painting of the periosteum with a 10 per cent formalin solution (to avoid rib regeneration and to make retraction of lesions possible even later on).

2) Resection of the five to six upper intercostal nerves with the exception of the first (avoiding pain of and breathing with the anterior chest wall).

3) Pneumolysis from the first intact rib, in other words, from the fifth or sixth towards the base (sufficient in size for the luxation of the shoulder blade and to be enlarged according to the position and dimensions of the lesion).

4) Intrathoracic luxation of the shoulder blade as an osteomuscular filling and as an effective support for the resected thoacic region.

D) Chief Characteristics of Combined Thoracoplasty: No paradoxical breathing, normal respiratory functions unrestricted, no pain, no retention of sputum, no irritations of lesions, no further tuberculous spreads, surgical shock reduced to minimum, number of cases hitherto denied active treatment, operated, arm action almost unchanged, total absence of infection, results justify method, equal advantage with eight rib thoracoplasty, key position in collapse mechanism, no obstacle for further horizontal or vertical extension of thoracoplasty.