| Summary: | Bronchoplastic techniques: Plastic-reconstructive techniques in thoracic surgery have led to significant reductions of morbidity and mortality. Particulary the so-called sleeve resections are now commonplace in non-small cell carcinoma in stage I–IIIA, with rather similar five-year survival as conventional resections. Even with infiltration of large vessels (T4-stage), this technique can be applied even in the curative approach, e.g., replacement of the pulmonary artery by a vascular prosthesis (“double sleeve resection”).Extended resection of the anterior and lateral chest wall: Malignant tumors of the chest wall are caused by infiltration of the so-called T3-carcinoma of the lung, by primary bone tumors (e.g., chondrosarcoma) or by osseous metastases from extrathoracic malignancies (e.g., breast cancer). After “en bloc-resection” of the chest wall including the surrounding lung parenchyma, the large defect is covered by a muscle rotation flap (M. latissimus dorsi). Sometimes these muscle flaps can not be used, for example in cachexia. In these cases, the bony thoracic defect is reconstructed by a Goretex-patch (Goretex Dualmesh). Then the patient undergoes laparotomy or laparoscopy and dissection of the omentum of the great curvature of the stomach while preserving the right epiploic artery. Through a subcutaneous tunnel, the omentum is displaced to the thoracic wall to cover the Goretex-patch. To accelerate the wound healing, the omentum is covered with a polyurethane sponge, which is pressed with a suction of 125 mm Hg (vacuum therapy). At about 4 weeks, the healed omentum can be covered with a split skin graft.Intrathoracic infections: Severe thoracic infections (empyema, lung abscess) are usually caused by a pneumonia (80%) or are the consequence of operative complications (e.g., bronchial stump insufficiency).The infection is not curable with the conventional irrigation drains. Often the muscle rotation flaps fail, too. The combination of the transposed greater omentum and polyurethane sponges (VAC) leads to a faster cleaning of the soiled thoracic cavity and accelerates the wound granulation. With this technique, even unfavourable cases could be rehabilitated.Sternal wound infections: The osteomyelitis of the sternum is a potentially life-threatening complication (mediastinitis), especially after cardiac surgery. In these cases, the vacuum therapy (VAC) with polyurethane sponges have contributed to the improved prognosis. Firstly, a more rapid debridement is provoked, and second the chest wall will be stabilized more quickly, because the VAC reduces the shear forces in a dehiscence of the sternum. After reaching clean conditions, a muscle flap or the greater omentum are interposed for final wound closure.
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