Thoracoplasty Without Rib Resection by the Sawamura Technique: A Forgotten Technique for Effective Complex Pleural Empyema Management in a Single-Step

Treatment for complex pleural empyema often requires thoracoplasty with rib(s) resection to remodel the thoracic cage and obliterate chronic infected pleural cavities. Such procedures are complicated and result in permanent body deformation, which is not acceptable by most adults. Standard decortication often fails as there is residual space for reinfection development, and often necrotizing pneumonia co-exists. Here we describe the surgical management of three complicated adult patients using the modified version of the Sawamura technique which involves debridement and partial decortication followed by ribs stripped of periosteum and surrounding soft tissues, to allow collapse deep into the pleural cavity, thereby obliterating the chronic space in conjunction with partial lung re-expansion. We utilized the serratus muscular flap to repair any bronchial defects due to resected gangrenous parenchyma. No further reoperations were necessary, and no residual effusions were drained. At the 6-month follow-up, these three patients experienced no complications, and their body shapes and functionality were unaltered. This modified Sawamura technique offers an effective single-step treatment while being cosmetically suitable for young adults, and presents an extremely attractive option in countries with limited healthcare resources.