Key Points

• Current indications for thoracoplasties include postpneumonectomy empyemas and infected apical spaces.
• Most thoracoplasties are performed through a standard posterolateral thoracotomy, which can be extended upward, if necessary.
• An axillary incision can be used for limited thoracoplasty.
• Preservation of the first rib is important to maintain the integrity of the neck and shoulder girdle.
• The second to the eighth ribs are usually resected in an extramusculoperiosteal fashion.
• Apicolysis is a most important step of the operation.
• Successful obliteration of the space can be obtained in 80% to 90% of patients.

Thoracoplasty is a surgical procedure that was originally designed to permanently collapse the cavities of pulmonary tuberculosis by removing the ribs from the chest wall. Until supplanted by effective chemotherapy, it was one of several methods used to put the lung to rest, with the hope of inactivating the disease. Other methods, such as artificial pneumothoraces, intercostal neurectomy, scalenotomy, and phrenic nerve interruption, were also used with variable results for the same purpose.

Thoracoplasty is currently being used for the treatment of chronic pleural space infection when the lung cannot be expanded. Since the early 1960s, however, it has lost much of its popularity, not only because it is considered to be a mutilating procedure, but also because of the advent of better techniques of muscle transfer to fill infected spaces.

Despite this “bad press,” there remain a few patients with chronic empyema who have no remaining lung or a lung that cannot be expanded because of intrinsic disease, who are potential candidates for thoracoplasty. In this chapter, we describe the important technical points to consider in performing a thoracoplasty. We also attempt to define the role of this procedure in the context of contemporary thoracic surgery.