Apico-Axillary Thoracoplasty

Morelli: The author illustrates a type of thoracoplastic operation effected through the axillary way, which consists of freeing completely the upper lobe by eliminating the first five ribs, by means of posterior disarticulation.

Thus an homogenous detensive and concentric collapse is obtained at the level of the affected side, equivalent to an elective extrafascial pneumothorax (atmospheric pneumothorax).

Through this intervention, any tuberculous lesion localized in the upper lobe, either with a prevailing exudative or productive character, with acute or chronic evolution, unilateral or bilateral, micro-ulcerative or widely excavated is eligible for treatment.

Di Paola: The intervention carried out by means of instruments conceived by Dr. Morelli, consists of the total exeresis, through the axillary way, of the first three ribs, their disarticulation from their vertebral attachment, and of the resection of the latero-posterior segments of the fourth and fifth rib, which are also disarticulated; of the lowering of the apex by extrafascial way and the fixation of the same by helicoidal suture; of extrapleural or extrafascial detachment of the lung in its latero-posterior side, starting from the sixth costal arch to the level of the healthy area of the lung. Detailed late results are given.