A DEDICATED PROSTHESIS FOR OPEN THORACOSTOMY

Due to our dissatisfaction with the mutilation caused by the skin-line d open thoracostomy, we have developed a dedicated prosthesis that is expected to avoid or to substitute for the classic operation. The pros thesis is a corrugated silicone tube With an oval flange at one end (t o fix it internally) and a mobile ring on the other (to fix it externa lly). It is inserted at the bottom of the empyematic cavity after 3 cm of a rib is removed. We have used it in 20 patients whose empyema was secondary to pneumonia (12) or complications of pneumonectomy (4), lo bectomy (2), decortication (I), or pleuroscopy (1). Six of those patie nts have already been cured and their prosthesis removed after 54 to 3 05 days. In I with a persistent postpneumonectomy bronchopleural fistu la the device was removed after 299 days and the patient was submitted to a limited thoracoplasty. Six other patients still have unresolved cavities and have been using the prosthesis for 63 to 302 days. Seven patients died of their underlying disease (bilateral pneumonia, 2; acq uired immunodeficiency syndrome, 2; mesothelioma, I; heart failure and pulmonary embolism, 1; unknown, 1) after using the prosthesis for 11 to 160 days. In those patients from whom the prosthesis already has be en removed, the scar looks like those commonly seen after removal of a n ordinary chest tube. Based on these early favorable results we feel most encouraged to persist in this research. Nevertheless, we are awar e that a larger number of patients and a longer follow-up will be nece ssary before we may make definitive recommendations. (C) 1997 by The S ociety of Thoracic Surgeons.