Primary Anterolateral Thoracoplasty A Preliminary Report

¹ Chief Thoracic Surgeon at Clinica Fernández Garcia, Hato Rey, Puerto Rico.

1) We have presented a new concept in the performance of thoracoplasty for pulmonary tuberculosis. A history of the development of the method is given.

2) Primary, anterolateral, sub-pectoral resection of the anterior portions of the first four ribs is first carried out; this is followed within 15 days by a paravertebral operation in which the remaining posterior segments of the first four ribs, and three or four additional entire ribs, are removed.

3) We advocate the routine use of this operation in all cases in which two or more stages of thoracoplasty are contemplated. On the other hand, the patient with a small apical cavity who usually responds to a single three or four rib upper thoracoplasty should not be submitted to our anterolateral, primary stage.

4) A detailed description of the position, anesthesia, incision, operative procedure and bandage used has been given.

5) The following obvious advantages of the method may be mentioned:

a) It allows us to operate on patients with poor exercise tolerance, through an inconspicuous incision and with greater rapidity and safety.

b) It diminishes the number of operative interventions without sacrifice in the circumferential collapse.

c) It facilitates the performance of the second, posterior stage.

d) Avoidance of muscular section, paradoxical respiration, retained bronchial secretions, mediastinal flutter, post-operative shock, excessive use of suture material, excessive blood loss and post-operative transfusions.

6) We believe the method suggested merits a trial, and if found worthy its use should become general.