FIBROTHORAX AND DECORTICATION OF THE LUNG

1
FIBROTHORAX AND DECORTICATION OF THE LUNG

• GENERAL THORACIC SURGERY
• CHAPTER 61

2
Decortication

• Pelling or stripping a constricting menbrane from
  the pleural surface.
• Include 1). Intercostals incision, wide
• exploration of pleural
  cavity.
• 2). Full mobilization of
  lung.
• 3). Remove fibrous peel, not
  the visceral
• pleura,
• 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.

4
(No Transcript)
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 evaluationpulmonary function test,
  ABG.
• Indication and contraindication.
• Indication
• 1). Symptomatic extraparenchymal restrictive
• disease.
• 2). Tube thoracostomy, thoracentesis,
• thoracoscopy are fail to drain and
  expand of
• lung.

8
Treatment

• Timing 1). Hemothorax over 6 weeks.
• 2). More than 50
  compression.
• 3). Apex collapse.
• 4). In tuberculosis after
  chronic
• antituberculosis
  therapy.
• 5). No changes on chest
  x-ray.

9
Treatment

• Contraindication
• Major bronchial obstruction.
• Pulmonary destruction.
• Uncontrol sepsis.
• Chronic debilitation.
• Concomitant organ dysfuction.

10
Differential diagnosis

• Mesothelioma.
• Malignancy.
• Metastatic pleural disease.

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.

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Mortality and morbidity

• Mortality and morbidity0-8.
• 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.