Surgical choices in the treatment of lung gangrene

Patients with gangrene of the lung should be treated at a specialized thoracic department. Nonoperative treatment is justified only as preoperative management applied for no more than 2 weeks. Pneumonectomy is the operation of choice in gangrene of the lung. Pneumotomy may be conducted in patients who are in a very grave condition with respiratory and hemodynamic disorders.     

Diagnosis and treatment of acute limited gangrene of the lung

Based on an analysis of 49 patients with acute limited gangrene of the lung the author considers the main method of treatment of this disease to be a complex conservative treatment including the antibiotic therapy, sanitation of the gangrenous cavity and bronchial tree trachea, drainage of the abscesses, correction of immune disorders of the organism and normalization of the functioning of its important systems. The operative treatment is thought to be necessary in cases with severe complications such as bleedings, pyopneumothorax, septicopyemia. Operations under these conditions give high lethality rate and are followed by severe complications.     

Total unilateral lung gangrene in Hodgkin's disease: treatment by thoracostomy

Total gangrene of the left lung developed in a 30-year-old male patient with a pulmonary recurrence of Hodgkin's disease after mediastinal irradiation and chemotherapy. Clinically, tension pyopneumothorax and severe septic shock were present. Surgical repair was done by thoracostomy, resecting three ribs. A 2 x 0.5-cm hole in the necrotic wall of the left main bronchus was covered with an intercostal muscle bundle. The necrotic pleural surfaces were treated openly by daily change of dressings. The patient recovered satisfactorily and underwent four further courses of chemotherapy without any complications.     

Digital gangrene in small cell lung cancer: response to aspirin treatment.

A patient who had small cell lung cancer complicated by symmetrical peripheral gangrene, secondary to spontaneous platelet aggregation, improved dramatically after starting aspirin treatment.     

Surgical and combined treatment of lung cancer

An investigation of immediate and long-term results of treatment of 2028 patients with cancer of the lung (in 1267 patients the surgical treatment was combined with the radiation component) has shown that the combined treatment is indicated to patients with the II-III stages of lung cancer.     

Use of sodium cephalothin in the management of lung gangrene

Thirty-one of 256 cases of chronic destructive pneumonia who were judged, by the severity of illness and haemoptysis, to have lung gangrene, were managed with intravenous sodium cephalothin. Five patients died, two in relation to emergency pneumonectomy. In comparison with results of management of this disease in previous, similar patients, the results are encouraging.     

Successful combined approach to a severe Fournier's gangrene

We present a case of a successful reconstruction of a severe Fournier''s gangrene (FG) involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT), dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result.KEY WORDS: Dermal regenerative template, fournier''s gangrene, vacuum-assisted closure therapy     

Expansion of the lung after partial resection for gangrene

On the basis of the experience with the treatment of 69 patients with lung gangrene the authors recommend to use a combination of active aspiration from the pleural cavity, occlusion of the segment bronchus and pneumoperitoneum for the efficient expansion of the lung after its resection in the early postoperative period.