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J Thorac Cardiovasc Surg 2007;134:608-612
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Use of tissue expanders in adult postpneumonectomy syndrome

Anne Floor M. Macaré van Maurik, MDa,d,*, Bart M. Stubenitsky, MD, PhDd, Henry A. van Swieten, MD, PhD, MsScb, Vincent A.M. Duurkens, MDc, Erik Laban, MDa, Moshe Kon, MD, PhDd

a Department of Plastic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
b Department of Thoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
c Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
d Department of Plastic Surgery, University Medical Center, Utrecht, The Netherlands.

Received for publication December 27, 2006; revisions received May 3, 2007; accepted for publication May 11, 2007.

* Address for reprints: J. F. M. Macaré van Maurik, MD, UMC Utrecht, Department of Plastic Surgery, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. (Email: annefloor{at}hotmail.com).

Objective: Mediastinal shift and rotation after pneumonectomy can lead to severe symptomatic airway compression. Historically, a variety of treatments, such as muscle-flap transposition, pericardial fixation, and plombage, have been used. In this study we retrospectively evaluated the effectiveness of intrathoracic tissue expansion in postpneumonectomy syndrome.

Methods: Since 1990, our center has used tissue expanders as plombage in patients with postpneumonectomy syndrome. Between 1990 and 2005, a total of 20 patients were treated. The outcome was evaluated by using preoperative, perioperative, and postoperative bronchoscopy and imaging studies. Patient satisfaction was determined with a validated questionnaire.

Results: In 19 of the 20 patients, up to 3 tissue expanders were placed and filled within the pleural cavity. Access to the pleural cavity could not be obtained in 1 patient because of adhesions. Perioperative and postoperative bronchoscopic scans demonstrated decompression of the left main bronchus in 16 (84%) of 19 patients. On discharge, all patients reported improvement of their respiratory symptoms. Six (32%) patients required reoperation because of herniation (n = 2), luxation (n = 1), inadequate positioning (n = 2), and leakage of the tissue expander (n = 4). In 4 patients additional filling was performed in the outpatient clinic, with immediate improvement of respiratory distress.

Conclusion: Use of tissue expanders in adults with postpneumonectomy syndrome is an effective means of decompressing the remaining bronchus, thereby leading to a significant improvement in respiratory symptoms. Although 32% of patients required reoperation for complications, each complication was readily correctable.

Abbreviations and Acronyms CT = computed tomography; CVP = central venous pressure; PPS = postpneumonectomy syndrome; TE = tissue expander






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