Although resection is the method of choice for radical treatment of pulmonary tuberculosis, thoracoplasty has gained a well-deserved reputation in permanent collapse therapy, and although the results of. extrapleural pneumolysis have .became better, it is not always applicable because of some difficult condition and there are some detractions. Considering the defects, an extraperiosteal plombage was devised in hich a collapse is obtained by stripping the periosteum from the requisite ribs and inserting a plombage between the denuded ribs on the outer side and the periosteal beds and intercostal. - bundles on the inside. The periosteal beds and spongy intercostal bundles thus act as a buffer´between ´ the collapsed lung and the plombage.
This report concerns the follow-up of 50 cases of extraperiosteal plombage carried out from May; 1956 to Dec.1956.
All of, the selected patients received. unilatateral plombage and in some a secondary operation (15 -thoracoplasties, 1 removal of plombe) "followed. All cases had moderately or far advanced tuberculous lesions, namely-cavitations past or, present and at the time of operation these lesions were, considered unstable and required surgical thnerapy to ensure permanent healing, All were; poor, riske-fore. practically any other, type of surgery.
Early follow-up, was done in Sep., _1957 with the post operative period varying from 9 to 16 months, whereas, late follow-up in Aug.1960 had a post operative period varying from 3l to-51 years.´
Result In the early follow- up, 39 of 50 cases(78%) were satisfactory, 9(18%) were- fair.- I was bad and I died. Out of 9 cases of "fair" group, 5 had pyogenic - infection of the operative.site and 4 showed incomplete collapse of the lung. Incomplete collapse was caused by either -´contraction of the plombe or extreme consolidation of the lung. One bad result was due- to exacerbation of, disease in the contralateral lung and one death occurred on the sixth post-operative day.
At the time of late follow-up 2 cases were missed in this survey. Out of 48 cases (except. for .2) only. 25 cases (52.1 %). showed satisfactory results without any- complications. - At this time, there were 4 deaths.(1 early death and 3 late deaths) 1 case of bleeding, 13 infection (5 cases, aforementioned) and 8 additional ´cases of late infection), and 7 incomplete collapse (4 cases"" in early follow up and additional cases. The 3 additional cases showed contraction of the plombe). But out of 7 incomplete collapses, one case, which showed fair results in the early follow-up, improved-after prolonged chemotherapy and was well at the time of late follow-up. One other case was complicated by-infection recently There were 19 "fair" group. Out of 19, 16 underwent a second operation.. In 15 cases, the plombage was removed and -the denuded rib resected (thoracoplsty). In the remaining case only the plombage was removed without rib resection. Results after the second operation showed "satisfactory" -9, "fair"-1, "bad"-2, "death"-2,- "unknown"-2.
The Final results-from the second operation is as follows out of 46 cases, 34(73.9%) were satisfactory, 4(8.7%) were fair, 2(4.3/) were bad, and 6(13.0%) died. The Most frequent and serious -post-operative complication was infection, tuberculous or not. In - hour "cases, there were 5 early infections´-and 8 late infections. All were non-tuberculous. Another complication was bleeding. We had 5 cases which bled the amount varied from 200 to 700 cc.. One of these was profuse and persistent. In 4cases, effusion occurred in the operative space (3 cases) and in the pleural cavity for the other. The effusion was serous, odorless, straw-colored sometimes-mixed blood, and required aspiration 2 to 6 times in the period of 4 to 14 days after operation. In one case, it was profuse and required 6 aspirations with volumes amounting up to 860 cc. at times.
Mortality was 12% (6 of 50 cases), included 1. case (2%) of immediate death and 5 late deaths (10%). The Case of immediate death had been in shock from the beginning of the operation until the 6th post-operative day when he expired. At autopsy, marked fatty degeneration of the liver was found. Out of 5 late deaths, one committed suicide, one died of liver cirrhosis, one died of unknown causes after discharge from the hospital in good condition. The remaining 2 cases died. from exacerbation of pulmonary tuberculosis 4 and 6 months after the second operation respectively.
Only 3 deaths(6 %) were related directly or indirectly.with the operation.
Considering the relatively excellent results, eetraperiosteal plombage is a good substite for thoracoplasty and a good preliminary procedure of excisional surgery.
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