The indications for pleural decortication have been reviewed in relation to the postoperative results in 66 patients with pulmonary and pleural tuberculosis, and in 3 patients with traumatic hemothorax.The first consideration before a decortication is performed is to control the infection and proper management of the bronchopleural fistula, if present.The best indication is a decrease of function of the affected lung. In this respect restrictive disease characterized by a vital capacity of 70 % of the predicted or less constituted a good indication for decortication, this opinion is reinforced by finding a reduction of the vital capacity of the compressed lung more marked than the decrease in ventilation.These objective findings were accompanied frequently by an oppressive feeling in the affected hemithorax which was relieved by the operation. The results from decortication were better in patients with shorter duration of pulmonary compression, however, if the resting regional lung function studies such as radioisotopes and bronchospirometry demonstrate a very marked reduction of ventilation and perfusion in the affected lung, the studies should be repeated during exercise and or lateral decubitus to find out if there is an increment of function over the resting values. During exercise only differential spirometry and scintigraphy can be used. If differential spirometry can not be performed, examination with inhaled radioisotopes and or particles can provide information about the function of each lung.Other indication for decortication is to fill a residual pleural space secondary to infectious pleural disease. When the pleural disease is secondary to malignancy, decortication is not a suitable procedure and similar results can be achieved by placement of an intrapleural tube with suction.Decortication is contraindicated if the lung is not capable of reexpansion, this condition can be determined by regional lung function studies such as differential spirometry, gammagraphy, and angiocardiography.

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© 1970 S. Karger AG, Basel
1970
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