Aydin Nadir

Post-thoracotomy wound separation (DEHISCENCE): a disturbing complication

OBJECTIVES: We described the treatment of dehiscence of thoracotomy incisions in patients who underwent thoracic surgery in the present study. METHODS: Twenty-four patients with either partial or complete dehiscence of their thoracotomy incisions were included in the study from 2005 to 2010. The patients were evaluated regarding their age, sex, indication for thoracotomy, and surgical approaches. We also described our method of re-closure. RESULTS: The male/female ratio was 17/7. The youngest and oldest patients were 15 and 75 years old, respectively, and the mean age was 43 years. Among the indications for thoracotomy, empyema was the most common reason (determined in eight [33%] patients), followed by vertebral surgery (determined in six [25%] patients). Bacterial growth was detected in the wound site cultures from 13 (54%) patients. For the patients with dehiscence of their thoracotomy incisions, an en block approximation technique with debridement was performed under general or local anesthesia in 16 (66%) and eight (33%) of the cases, respectively. Three patients exhibited an open thorax with dehiscence of the thoracotomy incision. Thoracoplasty was required in two patients. Using this method, successful closure was obtained in 91.7% (n = 22) of the patients with dehiscence of their thoracotomy incisions. CONCLUSION: Dehiscence of the thoracotomy incision is an important complication that causes concern in patients and their thoracic surgeons and strongly affects the success of the surgery. An en block approximation technique with significant debridement that enables removal of the necrotic tissues from the wound site can successfully be applied to patients with dehiscence of their thoracotomy incisions.

Empyema in adults and children: difference in surgical approaches, report of 139 cases.

Abstract Aim: We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic. Material and methods: Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group. Results: The mean age was 5.6 years (4 mo — 17 y) for paediatric patients and 49.6 years (20–81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibri-nolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion. Conclusion: Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.

SURGICAL MANAGEMENT OF PULMONARY HYDATIDOSIS

Hydatid disease is generally regarded as a simple parasitic disease. However, it becomes troublesome in overlooked or complicated cases. Moreover, our knowledge about scolicidal and antihelminthic agents is still limited. Chemotherapy is not yet satisfactory.1 The reports that supported medical therapy diagnosed the patient using either radiologic or serologic method.2 Actually, these methods cannot confirm how many cysts are alive pathologically. The drugs may damage some of the cysts; however, some of them stay dormant for years. We can see them in reoperations. Clinical manifestations and radiological findings can be very different especially in complicated cases (Fig. 1). In uncomplicated cases, chest X-ray and computed tomography are sufficient for diagnosis. Serologic methods are 80–100% sensitive and 88–96% specific in diagnosis of liver hydatid cysts. However, they are not as sensitive in pulmonary hydatid cysts, so we do not use these tests.3 Surgical intervention is the dominant treatment method for pulmonary hydatid cysts. The objective of surgery is to preserve

Asymptomatic post-pneumonectomy over-expansion of the residual lung

A 23-year-old man had undergone right pneumonectomy 12 years previously for bronchiectasis in another clinic. Chest X-ray and three-dimensional computed tomography showed lung overgrowth (Figs. 1 and 2). Because a possible pneumothorax should be catastrophic for him, he should be closely monitored regarding any invasive diagnostic procedure. European Journal of Cardio-thoracic Surgery 24 (2003) 304–305 www.elsevier.com/locate/ejcts