Type of Surgery
Collapsed Lung Treatment - Pleurodesis Procedure
Last updated: 01/31/2010
Under normal circumstances, the lungs fill nearly the entire chest. The outer surface of the lungs rests right against the inner surface of the rib cage. Other than a thin coating of fluid, there is nothing that attaches the lungs to the chest wall. In fact, there is normally a vacuum in this space-when the chest expands, the lungs are pulled open by vacuum. Unfortunately since there are no physical attachments of the lungs to the chest wall, the lungs can collapse fairly easily. One treatment for a collapsed lung is pleurodesis.
Pleurodesis is a procedure in which the lung tissue is permanently affixed or attached to the chest wall. When the lung is attached to the chest wall, the chance of it collapsing is reduced. Not surprisingly, pleurodesis surgery is performed as a definitive treatment for repeated collapsed lungs in the same patient. It may also be considered as a treatment after the first collapsed lung (pneumothorax) in high risk patients and those that suffered a collapsed lung due to a medical condition. Patients with cystic fibrosis may benefit from pleurodesis, for example.
Most simple collapsed lungs can be managed medically with observation and by applying a face-mask using certain gases. The majority of cases of pneumothorax do not require surgical pleurodesis.
There are several types of pleurodesis procedures performed today. They include the placement of a sclerosing or scarring agent between the surface of the lung and the chest wall. Scarring agents commonly used in pleurodesis include talc, certain antibiotics, or fibrin (a protein involved in blood clotting). These sclerosing agents scar the surface of the lungs and the internal chest wall so that when the two surfaces heal, they heal together. It can be thought of like wound healing on the skin-the two edges of a wound heal as one. The same thing occurs in the chest during pleurodesis recovery except it is two different types of tissue.
Pleurodesis surgery can be performed at the bedside in many cases. The primary requirement is that the treating physician can access the lungs. This can be achieved by the placement of a chest tube. The chest tube is placed under sterile conditions by making an incision in the chest about the diameter of a finger between the ribs. Chest tubes can be inserted using local anesthesia, but the scarring agent that is put in the pleural space can cause pain as it is working. Therefore, some patients require intravenous sedation as well or even general anesthesia in select cases.
If chemical pleurodesis is not possible, it may be possible to perform a surgical pleurodesis. If the surface of the lungs is scraped, the resulting wound will attach the lung to the chest wall as it heals. Like chemical pleurodesis, surgical pleurodesis is painful and requires adequate pain relief.
Pleurodesis recovery takes about as long as it would take a wound on the skin to heal. The exception is that in the case of a collapsed lung, the lung must be re-inflated after the pleurodesis so that the surface of the lung can stay in contact with the interior chest wall.
Last Updated: 01/31/2010
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