Thoracoplasty with modified Hoist’s technique
Rao, K.N. (1954) Thoracoplasty with modified Hoist’s technique. Indian Journal of Tuberculosis, 1 (3). pp. 99-105.
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Thoracoplasty operation has proved to be one of the most successful collapse procedures in the surgical treatment of pulmonary tuberculosis. The ideal thoracop-lasty is one that produces permanent selective collapse with minimal deformity and the preservation of as much functioning lung tissue as possible avoiding the complications of paradoxical respiration and re-expansion of the lung. This aim contrasts strongly with the achievements of the earlier operations which are considered standard pro- cedures such as the Alexander type of thoracoplasty and the Semb’s thoracoplasty. The chief disadvantages of thoracoplasty operation are : (i) deformity ; (ii) multi-stage character of the operation ; (iii) paradoxical movement of the lung ; (iv) re-expansion of the lung in certain cases with the re-opening of cavities. In the Alexander type of operation even with the removal of the transverse processes only lateral and posterior relaxation is aimed at with immobilization of large portions of normal lung tissue. Only in Semb’s extra-fascial apicolysis both vertical and lateral relaxation known as concentric relaxation is obtained. Even then the disadvantages of multiple stages, paradoxical movement and re-expansion of the lung persist. Introduction of air into the Semb’s space and continuation of refills for some weeks to prevent the re-expansion has been advocated (Sweetman). Hagn evaluated apicolysis in thoracoplasty by comparing the late results of extra-fascial apicolysis with cases in which no apicolysis was done. He observed no significant difference in results except in a limited number of cases showing purely apical disease where apicolysis appeared to be an advantage.
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