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Ann Thorac Surg 1997;64:958
© 1997 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 954.

DR ROBERT J. CERFOLIO (Birmingham, AL):

I am just wondering why you are using a sternotomy which risks the sternum to infection, why you are reresecting the bronchus, and why you are using two operations (a Clagett procedure and a sternotomy) when you can accomplish all the surgical principles with one operation. At the University of Alabama at Birmingham our approach has been to do a redo thoracotomy, harvest the serratus anterior muscle, debride the pleural space, and then cover the bronchopleural fistula with the muscle. The bronchopleural fistula only needs to be plugged with muscle; a carinal resection or reresection of a long bronchial stump is not necessary. The chest is then aggressively debrided and filled with an antibiotic solution and closed. This technique has been very successful. Have you ever used this approach?

DR BRUTEL DE LA RIVIERE:

These comments are well taken. However, when we see these patients, who are usually referred to us rather late, then they have serious infection in their pleural space, and first we try to get rid of the infection by making a large window, and at that time, it would be highly unsuitable to go to the airway and try to close it, as this is really an infected area. Therefore, once you have opened the chest and you have packed it with gauzes, and changed these every day to get rid of the . . . [Full Text of this Article]

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Ann. Thorac. Surg. 1997 64: 954-957. [Abstract] [Full Text]

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