Application of mechanical and manual sutures enclosing the bronchus.

The mechanical suture was introduced into thoracic surgical procedures by Amonosow and Androsow, Soviet surgeons, in the late 50s. The aim of the paper is to compare the incidence of bronchopleural fistulae that develop after the mechanical suture has been applied in bronchus surgery with the corresponding figures for traditional manual sutures. In the period of January 1997-March 1999 a series of 524 anatomical lung parenchyma resections was performed at the Department of Thoracic Surgery, Medical Academy of Gdansk. In 460 cases (87.8%) the indication for the procedure came from primary lung carcinoma, and in 64 cases (12.2%) from tuberculosis, hamartoma, arteriovenous fistula, inflammatory lesions, asperpilloma, and metastases to the lungs. Depending on the way the bronchus was surgically closed the patients were subgrouped as follows: group I comprised 209 subjects (40.6%) whose bronchus was closed with a mechanical TA Premium Auto Suture, and group II that embraced 306 subjects (59.4%) whose bronchus was closed with a manual PDS 3/0 or Maxon 3/0 suture. The bronchopleural fistula developed in 11 cases of which 5/216 (2.3%) had the bronchus stump closed with a mechanical suture, and 6/308 (2.0%) cases had it closed with a manual suture. Of 11 cases of bronchopleural fistula 10 cases were noted after pneumonectomy. After the right side pneumonectomy, one fistula was discovered following the application of mechanical suture and six fistulas were found when the manual suture was used. After the left side pneumonectomy, no fistulae were discovered when the manual suture was used, and 3 those found were exclusively present when the mechanical suture was applied.

Posptneumonectomy empyema.

OBJECTIVE: Postpneumonectomy empyema can be managed in many different ways, with variable results. In the presence of bronchopleural fistula treatment is much more complicated. The results of therapy of postpneumonectomy empyema managed by thoracomyoplasty and closure of the bronchial fistula by pedicled muscle flap are presented. METHODS: Seven hundred and seventy-eight pneumonectomies had been performed for bronchogenic carcinoma. Empyema occurred in 35 (4.5%) cases. There were 22 (62.8%) patients with associated bronchopleural fistula. Depending on their management, patients were divided into two groups: I: 15 patients managed with tube and/or open-window thoracostomy only, II: 20 patients who were treated with thoracomyoplasty, which meant the excision of the fibrotic thoracic wall, combined with the transposition of the pedicled muscle flap into the empyema. There was a need to resect three to four ribs. Eight patients had large bronchopleural fistulas. Before thoracomyoplasty was conducted, tube drainage ranged from 16 to 120 days (average 46.6 days), the open-window thoracostomy ranged from 27 days to 13 years (average 574 days). RESULTS: Only one patient from group I was cured, there were five (33.3%) deaths. Nineteen (95.0%) patients from group II were successfully cured. Eight large bronchial fistulas were closed by suturing the muscle flap into the fistula lumen. The length of hospitalisation ranged from 9 to 30 days (median 17.6). The mortality rate in this group was 0%. CONCLUSIONS: The excision of the thoracic wall combined with the transposition of the pedicled muscle flap is safe and effective in the management of postpneumonectomy empyema. Bronchopleural fistulae can be definitely closed by suturing the pedicled muscle flap into fistular lumen.

[Mobilization of the pulmonary hilus from the pericardium in plastic surgery of the bronchi]. / Mobilizacja wneki plucnej z worka osierdziowego w plastycznych operacjach oskrzeli.

Since February 1990 to May 1996 we performed 69 operations of "sleeve resection" of the bronchi. "U" shape interior in pericardium was made below inferior pulmonary vein. Additionally, on the right side the inferior vena cava was mobilized. In this way 5 cm movement upwards of the pulmonary hilus was possible. Healing of the bronchial anastomosis was proper in each case. We conclude that performance of bronchial anastomosis without any tension in suture line is the most important factor for obtaining good healing of the bronchi.

High doses of hydrocortisone improved tracheal autograft revascularization.

OBJECTIVE: Anti-inflammatory effects of steroid to revascularization of the tracheal autografts in pigs, with the use of pedicled muscle flaps of the abdominal rectus was evaluated. METHODS: The research was done on 19 pigs. First group: eight pigs, no steroids were given. Second group: 11 pigs, a daily dose of 30 mg/kg hydrocortisone was given, starting on the day of operation. A segment of trachea ten rings long was skeletonized and excised, and reimplanted in the previous position. A muscle flap was sutured on the anterior aspect of the tracheal autograft. RESULTS: All eight animals in the first group died from graft failure. In the second group receiving steroids, only two animals succumbed (18.1%). Nine animals recovered, and were put to sleep 30-42 days following surgery. The average diameter of the grafts was 85%. Microscopically, all structures of the trachea were preserved. Grafts perfusion was on average 80.6%. CONCLUSIONS: Two conditions have to be fulfilled for tracheal autografts to survive: One, well vascularising muscular flaps have to be employed, and second, a high dose of steroids must be given starting on the day of operation.

[A case of eosinophilic granuloma localized in the bronchial wall]. / Przypadek ziarniniaka kwasochlonnego zlokalizowanego w scianie oskrzela.

A case of eosinophilic granuloma of the lung in a 24 years old male is presented. The initial manifestations were hemoptysis and cough. During hospitalization the bronchoscopy was performed, which revealed granuloma in the right bronchus. Computer tomography showed tumour in the right bronchus, without pulmonary changes characteristic for histiocytosis X. The granuloma was removed by bronchoscopy, but control examination performed after three months showed the residue. Once again residual tumor was removed by bronchoscopy and oral steroids were ordered. Unfortunately the next local residue was observed and the residual tumour was finally removed by thoracotomy. Now patient is free of symptoms.

[Pleural empyema as a complication of descending necrotizing mediastinitis]. / Ropniak oplucnej jako powiklanie zstepujacego martwiczego zapalenia sródpiersia.

Fulminant infections of oropharyngeal origin may cause the most lethal form of mediastinitis due to extension of the infection along the neck fascial planes or by lymphatic way: descending necrotizing mediastinitis. Two cases of this rare life-threatening entity of odontogenic and tonsillar origin are reported. A pleural empyema and pericarditis as complications were observed. Bacteriologic etiology, possibilities of the early diagnosis and the aggressive treatment by means of a thoracotomy are discussed.

[Reconstruction of the dysfunctional thoracic cage after removal of the sternum and ribs]. / Odtworzenie zaburzonej funkcji klatki piersiowej po wycieciu mostka i zeber.

Indications for sternectomy and chest wall resection are considered very carefully due to risk of disturbances in respiratory mechanics. It was assumed that the major respiratory component abnormality after sternectomy and chest wall resection is the excessive mobility of rib stumps left in situ, whereas, the chest defect itself is of lesser importance. 5 patients with sternal tumour and 56 patients with lung cancer were operated and the chest wall resection was performed. In reconstructing the chest wall, the greatest emphasis was laid on rib stump stabilisation. This was carried out by attaching the rib stumps to each other using single sutures. Thanks to this, the rib stumps formed a rigid ring around the defect. Especially, a case of complete sternectomy, in which stabilisation required the fixation of large number of rib stumps, indicates the correctness of this hypothesis.