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Ann Thorac Surg 1997;64:225
© 1997 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Historical Comment

	Introduction

Top Introduction

 
See also page 220.

After Tuffier's introduction of extrapleural pneumolysis in 1891, many substances were tried in the space created, as plombage, to maintain local collapse of the underlying lung. A partial list includes fat (Tuffier 1910), air (Mayer 1913), oil (Graf 1913), paraffin (Baer 1913), rubber bag (Gwerder 1924), muscle (Alexander 1932), fiberglass (O'Neal 1946), and polyethelene (Cleland 1942). Of these early plombage materials, paraffin was used the longest, but all were eventually discarded because of complications including infection, erosion, migration, fistulas, and substance expectoration.

In 1945, David A. Wilson, while a resident surgeon at Duke University Hospital, suggested hollow Lucite (methyl methacrylate) balls after his animal experiments confirmed Lucite spheres to be well tolerated and virtually inert in tissues. In May 1946, Wilson described 15 patients with cavitary tuberculosis who were either unsuited for or had had failed thoracoplasty and who had undergone extrapleural pneumolysis with Lucite ball plombage. He reported 13 of these patients improved, but cautioned regarding his small number of patients and short follow-up of 4 to 10 months. The operation was continued at Duke only until November 1946, and then abandoned, because of the increasing number of delayed complications. In 1948, the late Josiah C. Trent, then Duke Chairman of Thoracic Surgery, in an evaluation of the operation, reported that within less than 2 years 31.3% of the 51 Duke patients had suffered serious late complications. Many of these were not unlike those described by Massard and associates.

The Lucite ball operation, because of its simplicity and patients' tolerance compared with thoracoplasty, and in spite of Trent's warning, was continued in many places well into the mid-1950s.

This report by Massard and associates and the report by Shepard (1985) show convincingly that the few remaining survivors of this obsolete operation may remain at risk for serious complications even after 30 or more years.

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Long-Term Complications of Extraperiosteal Plombage

Gilbert Massard, Pascal Thomas, Pierre Barsotti, Pierre Riera, Roger Giudicelli, Eugène Reboud, Georges Morand, Pierre A. Fuentes, and Jean-Marie Wihlm
Ann. Thorac. Surg. 1997 64: 220-225. [Abstract] [Full Text]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brown, IvanW. Search for Related Content PubMed Articles by Brown, IvanW., Jr Related Collections Related Article