LONG-TERM COMPLICATIONS OF EXTRAPERIOSTEAL PLOMBAGE

Background. As soon as complications due to migration of extraperioste al plombage material had been documented, early removal became the rul e. Some patients who have escaped this rule may still present with lon g-term complications. Methods. Since 1980, 14 patients aged 54 +/- 10 years were admitted 28 +/- 11 years after collapse therapy. Eight pres ented with signs of infection, 4 with hemoptysis, and 2 with periscapu lar pain. Vascular erosion, suspected in 3 patients, was demonstrated with angiograms in 1. Results. Ablation of the material was combined w ith excision of the devitalized ribs in 13 patients. Femorofemoral byp ass was used in 2 patients for repair of an aortic erosion. Single abl ation of subcutaneously migrated material was performed in a poor-risk patient. Operative bleeding was moderate except in 2 patients; 1 of t hem died intraoperatively during repair of an aortic erasion. A second patient died postoperatively with a massive pulmonary embolus on day 11. Infection was diagnosed in 8 patients (Mycobacterium tuberculosis, 4; and pyogens, 4). Operative outcome was satisfactory in all 12 oper ative survivors. A single patient presented with an infected apical sp ace at 1 year and underwent complementary resection of the first rib. Conclusions. We recommend routine ablation of any residual plombage ma terial whenever operative risk is acceptable because of the high incid ence of spontaneous complications. (C) 1997 by The Society of Thoracic Surgeons.