Surgical treatment for chronic lung and thoracic cavity infection

To avoid the complication of aspiration pneumonia, we attempted a new anterior approach of extrapleural pneumonectomy combined with thoracoplasty in four patients with chronic empyema, a bronchopleural fi stula, and severely destroyed lung. The thoracic cage was exposed by an L-shaped parasternal incision making a muscle-skin flap of the anterior chest. The anterior portions of ribs were removed at fi rst, and exfoliation was started in the mediastinal area. After detaching the lung from the mediastinum, an extrapleural pneumonectomy was completed. The backside ribs were then resected by way of the thoracic cavity. The muscle-skin flap was sutured to close the thoracic cavity completely. The procedure was tolerable for three cases. One patient died from accidental rupture of the descending aorta owing to atherosclerotic degeneration. Of the three successful outcomes, recurrence was observed in one case, although it was recurrence of malignant lymphoma associated with chronic empyema.