Annual and analytical cyclopaedia of practical medicine . andtissues adherent or attached to the ribs,with the exception of the skiji, the fascia,and the parietal pleurae, and these arestitched together and form the only pro-tection to the chest at the point of theoperation, and the only hope of restoringthe tissue lies in the granulating process. The incision is a T-shaped one, ex-tending from the axilla in front down-ward to the limit of the pleura and back-ward and upward to the second rib, lift-ing the scapula in the removal of thebony flaps. This operation has been ad-vised as a modificat
Annual and analytical cyclopaedia of practical medicine . andtissues adherent or attached to the ribs,with the exception of the skiji, the fascia,and the parietal pleurae, and these arestitched together and form the only pro-tection to the chest at the point of theoperation, and the only hope of restoringthe tissue lies in the granulating process. The incision is a T-shaped one, ex-tending from the axilla in front down-ward to the limit of the pleura and back-ward and upward to the second rib, lift-ing the scapula in the removal of thebony flaps. This operation has been ad-vised as a modificatif)n of Estlandersoperation, in ca.^es where the pleura ismuch thickened and wliere the walls failto respond to ordinary means of reducingthe cavilv of tlio chest. 104 EMPYEMA. TREATMENT. Estlanders operation—wliich consistsin removing, not only a certain lengthor a certain number of ribs, but all theribs lying in the wall of the empyema—performed twelve times, the resultsbeing nine cures and three deaths, onefrom tuberculosis, the second from car-. Fig. 1.—Schede s incision for thoracoplasty.{Keen.) diac disease, and the third from albu-minuria. J. Boeckel (Revue Chir., , 88). Extensive thoracoplasty by Schedesmethod performed in a case of thoracicempyema of twelve years duration. Sec-ond operation performed three monthsafter first. Recovery was without inci-dent, though slow. Eight months afterthe second operation the wound brokeopen again and discharged a smallquantity of pus. By a third operationsome more of the chest-wall at the upperposterior angle was removed. A cavitythree and one-half inches long and asthick as the tlmmb was found. Thiswas nearly obliterated by granulation-tissue. W. W. Keen (Annals of Surgery,June, 95). One hundred and twenty-nine cases ofempyema treated by resection of thechest-wall, in which per cent, werehealed, 20 per cent, improved, 3 per cent,unchanged, and 20 per cent. died. There is little or no tendency to spinal curva-ture o
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