Healing of Tuberculous Pulmonary Cavities by Means of Skin Grafts

Abstract

Giant tuberculous pulmonary cavities continue to present one of the most complex problems in the surgical treatment of pulmonary tuberculosis. Various types of collapse therapy have resulted in a high percentage of failures. Intracavitary drainage in tension or blocked cavities, combined with collapse therapy, has greatly increased the number of good results. Intracavitary drainage without collapse therapy provides relief from toxicity but is of little value in cavity closure. In advanced pulmonary disease with multiple cavitation, collapse therapy is contraindicated. We wish to present a somewhat different point of view. Let us consider that a tuberculous pulmonary cavity is a chronic lung abscess: The lung surrounding a chronic nonspecific lung abscess shows little disease. When such an abscess is drained, the surrounding lung tissues fill in the defect occupied by the abscess. In a tuberculous lung abscess, the surrounding lung tissues are usually diseased and cannot expand to fill in the space occupied by the abscess cavity. Drainage is of cleansing value in pulmonary tuberculous cavities, as in other types of pulmonary abscesses, but cavity obliteration does not occur without collapse therapy. At the Grace Dart Home Hospital large cavities have been treated by intracaavitary drainage. The residual cavity space has been opened into by cavernostomy, carried out through the sinus tract of the drainage tube. The exposed cavity walls and floor have been covered with split-thickness skin grafts or pinch grafts. Gradually the boundaries of the cavity are lined with skin which grows out to meet the skin on the surface of the chest wall. The cavity thus becomes obliterated, leaving a defect in the chest wall. The first case selected was a 5 2-year-old male with far-advanced bilateral pulmonary disease with giant bilateral apical cavities.