Pulmonary detachment (tentative term) consisting of ablation as a main technique and decortication as an adjunct was performed on 24 patients with chronic empyema during the period between 1975 and 1983. The results of surgery were analysed in relation to disease type, age, state of pulmonary collapse, and pulmonary function and an attempt was made to find out causes of failure in the first stage surgery. Our results suggest that the pulmonary detachment should be confind to cases with difficulty for pulmonary decortication, total empyema, pulmonary function of % VC>60 and FEV1.0%>70, absence of a marked disturbance in gas exchange, and pulmonary collapse index 0.5 or higher on the chest X-ray film. Furthermore, it is underlined that for patients who have risk to develop insufficiency of pulmonary expansion after surgery by this technique, the concurrentuse of extraperiosteal detachment is effective in preventing a new fisula, thereby increasing the success rate of the first stage surgery.
