DECORTICATION

Decortication is a term which is used to refer to the removal of a rind or

peel. In a medical context, the term means removing the fibrous outer layer of
tissue which covers an organ. Most typically, decortication is used in the
management of certain lung conditions, most notably in tuberculosis and
mesothelioma. People have been using this technique since the 20th century,
and it is important to note that it is a palliative measure, not a treatment or cure.

In decortication of the lung, the most common form of this procedure, the
patient is placed under general anesthesia and the chest cavity is opened. The
surgeon identifies areas of the pleural membrane which have become fibrous
and scarred, and removes them. Then, the surgical site is closed and the patient
is brought out of anesthesia. This surgery is major and quite invasive, and
requires several days of monitoring in the hospital after the surgery is complete
to confirm that a patient is healing well.

Lung decortication is commonly performed because thickening of the

pleura is causing pain or discomfort for the patient. If the thickening progresses
enough, it can lead to difficulty breathing, because the involved lung may have
difficulty reinflating since it cannot push the pleura out of the way. This can lead
to shortness of breath and a cascade of other medical issues as the patient
struggles with lack of oxygen.

This procedure may be recommended to increase patient comfort or to

address immediate breathing problems. In the long term, measures need to be
taken to address the reason that the membrane thickened in the first place. In
cases of cancer, for example, radiation can be used to shrink the tumor, and if it
is feasible to do so, a surgeon can remove the growth of rogue cells. It is
important to address the underlying cause once the patient has been made
comfortable.

Decortication surgery is not a procedure to take lightly. Patients should

discuss the reasons that the surgery is being recommended with their physicians,
and they should make sure that they understand the potential benefits and risks.
It is also advisable to ask about aftercare instructions, including those related to
the use of prophylactic medications to prevent infections. Something to consider
for patients who are terminal and are thinking about focusing on palliative care is
whether or not they want to go through the surgery, given their conditions. Each
case is different, and a doctor can provide information and advice specific to
unique circumstances.

Decortication is usually a palliative procedure, meaning it simply relieves

the symptoms and not the actual disease, as in cancer cases. Decortication
would be performed especially when a complete removal of a tumor is not likely.
Thus the decortication would remove the pleura that is mostly effected by the
tumor. This procedure would control any possible fluid build up and thus make
the patient much more comfortable by improving their breathing and decreasing
pain.

General anesthesia is required for a decortication and the procedure is

considered major thoracic surgery. An incision is required to gain access to the
affected area.

Another option for surgeons is a thoracotomy, an open surgical procedure

that is much more complicated than decortication. Thoracotomy requires a
surgical incision into the chest and is much more invasive.

Decortication Post-Operative Care

After surgery, the patient will likely remain in the hospital for up to a full
week during initial recovery. Total recovery may take between four and six
weeks. Frequently, doctors prescribe a post-surgical regiment of chemotherapy
or radiation treatment to serve as complementary treatments to the decortication.

During the initial month of recovery, oncologists will likely encourage the
patient to engage in routine breathing exercises and undemanding physical
activity. The purpose of this is to improve chest mobility and reduce the
possibility for infection.

Potential Complications

Decortication is not without its risks. Though unlikely, serious

complications can occur. For example, damage caused to lung tissue underlying
the thin pleura is a possibility. Complications may also arise related to blood loss
or breathing obstructions.

Even when taking these complications into account, the majority of oncologists
will recommend this procedure if it is deemed to be effective. Compared to alternative
radical procedures - such as extrapleural pneumonectomy - decortication exhibits lower
mortality rates due to surgery.
 THORACOPLASTY

Thoracoplasty involves shortening select ribs in the chest area. It is a fairly

common procedure for people suffering from scoliosis, since it works to make the
rib hump that is caused by scoliosis smaller and less severe. Typically, a patient
will undergo thoroplasty after she has undergone the corrective procedure for
scoliosis. Thoracoplasty is also used to manage pulmonary disease. For
example, if parts of the chest cavity are infected from tuberculosis, mycobacteria
or other postpneumonic issues, the procedure may be a life-saving option.

In scoliosis, thoracoplasty can reduce the outward deformity caused by a

rib hump, thereby improving the general appearance of the patient. In addition, a
rib hump can be quite painful, so removing it may reduce or relieve the pain
associated with the condition. For example, if a patient experiences discomfort
when she leans against the back of a chair, removing the rib hump can help
lower the level of discomfort.

Generally, a doctor will discuss with her patient where the thoracoplasty
will be on the body. Since the ribs will be shortened to relieve pain and alleviate
the rib hump, each patient’s case will be analyzed and considered. For scoliosis
cases, the amount of rib removed will depend on the curve of the spine and the
severity and size of the hump.

The surprising thing with the human body is that the rib or ribs grow back
and create a new rib or ribs over two to four months time after the thoracoplasty
is completed. The new rib will be just as strong as the prior rib, once the healing
process is complete. Unfortunately, if the curvature of the spine continues and
worsens, the rib hump could return. Consequently, it is important to treat the
scoliosis, as well as remove the rib hump.

After the thoracoplasty, most patients wear a brace to protect the chest
cavity from the ribs. Doing so will prevent the ribs from rubbing against the
internal organs of the chest and reduce the chances that fluid will collect in the
chest cavity, calling for a chest tube. Basically, the brace reduces the chances for
immediate complications, although it does nothing to improve the outcome of the
surgery. In addition, the unprotected chest wall faces few dangers from everyday
activities. Of course, if a traumatic injury were to occur, it could damage the chest
wall.

A patient who decides to go forward with the thoracoplasty procedure

should expect to spend four to eight days in the hospital. In addition, full recovery
can take several months. It is important to discuss all concerns and address any
questions with a reputable surgeon before undergoing this procedure.
These diseases and conditions may be treated with the surgical procedure
Thoracoplasty:

• Empyema (e.g. due to pneumonia)

• Tuberculosis
• Bronchopleural fistula (pleural space)
• Thoracic surgery
• Chest trauma
• Scoliosis

Possible surgical complications of Thoracoplasty may include:

• Bleeding
• Infection
• Respiratory failure
• Adverse reaction to anesthesia

Other names for this medical surgical procedures (Thoracoplasty) include:

• Rib resection
• Rib thoracoplasty