This was a primary operation for tuberculosis in the past, the philosophy being that decrease in the dead space resulted in collapse of the lung and prevention of growth of the tuberculosis. The indication now is for chronic empyema with excess dead space. It is a rarely performed procedure, nonetheless. Ordinarily, seven ribs are resected, not including the first rib. The incision is a long parascapular incision from the spine of the scapula and extending to the tip of the scapula. Ribs are resected subperiosteally from the transverse process anteriorly to the costal cartilage anteriorly. The immediate physiologic changes include increased effort of breathing due to paradoxic motion. The cough mechanism is reduced because of the unsupported chest. Scoliosis long-term can result in further decrease in pulmonary function.

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