Surgical Collapse Therapy: A Historical Treatment for Tuberculosis

Surgical collapse therapy—including thoracoplasty, pneumonolysis, and phrenic nerve crush—was a historical treatment for pulmonary tuberculosis in the pre-antibiotic era. The strategy intentionally collapsed the affected lung to "rest" it and promote healing.

Procedures

• Thoracoplasty: Resection of 4–8 ribs to collapse the chest wall and underlying lung.
• Pneumonolysis: Lysis of intrapleural adhesions to allow lung collapse.
• Phrenic Nerve Crush/Section: Paralysis of the hemidiaphragm to induce passive lung collapse.
• Plombage (Extrapleural Pneumonolysis): Placement of inert material (lucite balls, paraffin) extrapleurally to compress the lung.

Historical Context

• Used from the 1930s to 1950s; mortality 5–15%; significant deformity, chronic pain, and respiratory impairment were common sequelae.
• Obsoleted by effective antibiotics: streptomycin (1944), isoniazid (1952), rifampin (1960s).
• Classified historically under "Respiratory System → Lungs and Pleura → Surgical Procedures."

Modern TB treatment relies on a 6-month multi-drug regimen (RIPE: rifampin, isoniazid, pyrazinamide, ethambutol). Collapse therapy remains of historical interest only.