Presentation on theme: "FIBROTHORAX AND DECORTICATION OF THE LUNG"— Presentation transcript:
1 FIBROTHORAX AND DECORTICATION OF THE LUNG GENERAL THORACIC SURGERYCHAPTER 61
2 DecorticationPelling or stripping a constricting menbrane from the pleural surface.Include– 1). Intercostals incision, wideexploration of pleural cavity.2). Full mobilization of lung.3). Remove fibrous peel, not the visceralpleura,4). Suction and drainage.VATS.
3 Pathophysiology of fibrothorax cause of fibrothorax table 61-1.pleural fluid undrained, deposits fibrin on visceral and parietal pleura.Thin layer of immatured blood vessel and loose collagen forms.Organization produce dense avascular collagen matrix wall of the insulting fluid.Pulmonary compression, atelectasis. Entrapment of lung,encasement of thoracic cage produces a restrictive ventilatory defect.
5 Diagnosis and evaluation Symptom /Sign— Chest tightness, frank pain, dry nonproductive cough, fatigue, malaise.PE— Unilateral fixation of chest wall, reduce excursion of isilateral hemidiaphragm, dull to percussion, impaired transmission of breath sound.
6 Diagnosis and evaluation Chest x ray— Obliterate the costophrenic angle, narrow intercostals space, diminished the hemithorax, retraction the mediastinum to the fibrothorax, pleural calcification.CT— Assess the underlying pulmonary parenchyma for tuberculosis, bronchiectasis, mass lesion.
7 Treatment Preoperative evaluation—pulmonary function test, ABG. Indication and contraindication.Indication—1). Symptomatic extraparenchymal restrictivedisease.2). Tube thoracostomy, thoracentesis,thoracoscopy are fail to drain and expand oflung.
8 Treatment Timing— 1). Hemothorax over 6 weeks. 2). More than 50% compression.3). Apex collapse.4). In tuberculosis after chronicantituberculosis therapy.5). No changes on chest x-ray.
9 Treatment Contraindication— Major bronchial obstruction. Pulmonary destruction.Uncontrol sepsis.Chronic debilitation.Concomitant organ dysfuction.
11 Technique Bronchoscope exclude endobronchial lesion. Posterior lateral thoracotomy.Resection ribs.Blunt dissection the parietal peel, plane between the endothoracic fascia and parietal pleura.
12 Technique Prevent injury of diaphragm and phrenic nerve. Thicked parietal peel in incised.Empyectomy with preservation the integrity of cavity for tuberculosis.Perioperative antibiotics, material is cultured.Pulmonary decortication with incision fibrous peel overlying the visceral pleura.Chest tube drainage.
18 Mortality and morbidity Morbidity— Sepsis, wound infection, empyema, hemorrhage, prolong air-leak, bronchopleural fistula.Result— Absence of underlying parenchymal disease is best improve. Phrenic nerve injury, tuberculosis are less improve.