One stage thoracoplasty using an adhesive hemicast.

The day of routine single stage thoracoplasties has been brought nearer with the control of shock by using adequate blood replacement and with the control of respiration during operation by a tracheal intubation and the use of curare. Laird and Lindenfield presented a series of 72 single stage thoracophasties in 1950 to the American Association for Thoracic Surgery. These operations were done on selected patients. Contrary to Laird’s finding that the control of paradoxical respiration did not present a problem, we have found that even normal three rib operations are occasionally marked by noticeable respiratory embarrassment caused by paradoxical respiration. We have attempted to solve this problem by developing an adhesive hemicast for the thoracic cage, the use of which we have been investigating under varying circumstances. We are now convinced, so far as the immediate post-operative period is concerned, that if the patient is a good enough risk for any type of pulmonary resection he is also a satisfactory risk for almost any degree of one stage thoracophasty. As a final estimate of the effectiveness of this procedure can only be made over a period of several months post-operative study, the present paper is presented as a preliminary report. The requirements to be met by such an aid as a half cast to the chest wall are many. 1) It must be effective in preventing paradoxical respiration. 2) It must allow effective use of the contralateral side. 3) It must allow satisfactory clearing of the bronchial secretions on both sides. 4) It must be sufficiently flexible to allow enough movement of the shoulder to prevent fixation of the scapula to the chest wall: 5) It must be easy to apply, and it must be applicable to many different types of thoraces-f at, thin, full breasted. etc. Finally, it must not interfere with the healing of the wound and must be easily removable. During the period, February to June 1951, 17 patients undergoing thoracoplasty at Tranquille Sanatorium have been routinely subjected to the following procedure. The anaesthetic is administered via tracheal intubation which is performed using sodium pentothal and curare. An ordinary first stage thoracoplasty is then performed removing the third rib first, then the second and finally the first rib. The ribs are removed with their transverse processes and their cartilages in the case of the first three. Half the cartilage of the fourth rib is also removed with the fourth rib