Abstracted from a medical paper written by Wang Cheng, Jin Feng et al. Published in 2009/01 Chest Diseases 鈪 ninth issue. Chest wall tuberculosis is a common disease of the chest wall. Diagnosis and treatment seem to be simple, but if there is insufficient understanding of its pathologic characteristics and the specificity of the lesion, it will be mishandled and prone to recurrence. Some patients even need multiple surgeries to be cured, which brings serious adverse consequences to patients physically and mentally. On the basis of summarizing the lessons learned from the past, we have continuously explored the surgical treatment techniques and improved the surgical methods, and achieved satisfactory results. Wang Cheng, Department of Thoracic Surgery, Shandong Chest Hospital, China Chest wall tuberculosis is a local manifestation of systemic tuberculosis, and anti-TB treatment is the foundation of the whole treatment process. Patients with small lesion range, normal blood sedimentation and no symptoms of tuberculosis poisoning should generally be anti-TB for 2-6 weeks before operation; patients with large lesion range, rapid blood sedimentation and symptoms of tuberculosis poisoning should be strengthened with anti-TB treatment to make the lesion relatively stable and then shrink. This can not only make the chest wall tuberculosis foci shrink, but also the tuberculosis foci outside the chest wall tuberculosis foci are also in a relatively stable state, which not only reduces the scope of the operation, reduces the trauma of the patient, but also prevents the foci or latent tuberculosis bacilli in other parts of the body from activity, deterioration or dissemination to the maximum extent. Chest wall tuberculosis is a common disease of the chest wall, mainly manifested as chest wall abscesses, masses or chest wall sinus tracts. Chest wall tuberculosis abscess mostly originates from the lymph nodes deep in the chest wall and spreads to the superficial chest wall through the intercostal muscles. There is an abscess cavity inside and outside the intercostal muscle layer, which is connected by sinus tracts in the middle, in the shape of a dumbbell, and some abscess cavities can lead to all sides through several sinus tracts, while some sinus tracts can sneak under several ribs for a very long time, and the primary lesion is often not in the same place as the chest wall abscess, which can easily result in incomplete removal of the lesion. Accurate preoperative understanding of the scope and distribution of the lesion is a prerequisite for successful surgery, and ultrasound and CT scan are effective means of lesion localization. ultrasound is inexpensive, direct, and helpful in detecting abscesses located in the deeper part of the chest wall with little fluctuating sensation or a dumbbell shaped abscess, and experienced ultrasound examiners are able to accurately detect the existence and scope of the abscess, while a CT scan is highly objective, and can more clearly show the destruction of the bone quality, CT scan is more objective and can more clearly show the destruction of bone, the scope of the lesion, and whether the lesion is related to the thoracic cavity, lungs and thoracic vertebrae, so as to avoid missing the lesion. Based on the preoperative examination and intraoperative exploration, we can flexibly adopt different surgical styles and reasonably apply surgical techniques to approach the primary lesion at the shortest distance and minimize the damage to chest wall tissues such as muscles, intercostal nerves, and blood vessels, so as to reduce the trauma and pain of the patient. The sinus tracts submerged under several rib beds are removed, and the sinus tracts are opened to the blind end one by one by cutting the walls of the rib beds and the sinus tracts underneath them in the direction parallel to the intercostal blood vessels and intercostal nerves under the guidance of a spatula or curved forceps in the sinus tracts. In this way, the sinus tract is opened accurately and sufficiently to remove the lesion completely, and damage to the intercostal vessels and nerves is avoided. When the lesion of the lower chest wall flows into the subquaternary ribs to form an abscess or sinus tract, after removing the subquaternary lesion, the sinus tract is carefully probed along the sinus tract with a probe, and when it cannot be advanced upward, the chest skin is gently lifted up with a probe in the sinus tract to determine the location of the chest skin incision, and then all the incisions are made along the direction of the rib alignment to reveal and remove the main lesion, and the sinus tracts under the cover of the rib arches are carefully scraped by the upper and lower divisions. The rib arch is not severed so as not to destroy the protective effect of the rib arch on the liver and spleen. The lesions in the costal arches tend to flow from the costal cartilage junction along the junction ribs in multiple directions, forming the so-called “crabfoot-like” changes. If we are satisfied with the removal of only a single lesion, we may easily miss other lesions, and we should carefully search for the lesions from the costal junctions in the operation so as not to miss the lesions. For paraspinal and retrosternal lesions, after removal of the lesion, the sternum should be bitten to remove the part of the sternum that affects the closure of the residual cavity, and the sternum section should be trimmed into a saucer-like slope, and care should be taken not to injure the intercostal blood vessels and internal thoracic artery. It is advisable to use electrocoagulation to cut the periosteum at the intercostal muscle attachment by tightly adhering to the upper and lower edges of the ribs, in order to reduce the bleeding of the wound by reducing the peeling surface. The pleura at the lesion is hypertrophied due to the stimulation of the lesion, and careful stripping will not lead to pleural injury, but the pleura outside the lesion can be unthickened, and most of the damage to the pleura occurs here when stripping the ribs. The key to avoid damage to the pleura and adjacent blood vessels is that when stripping the periosteum, the periosteum should be fully stripped tightly against the bony tissues, and the force should be gentle, avoiding violence and uncontrolled force. After thorough removal of the lesion, the adjacent muscles should be fully freed, loosened and folded and sutured along the gap without affecting the blood flow, the bottom layer is used to fill the trauma cavity, the top layer is used to cover the reinforcement, and the overlapping and cross sutures between the muscles of different levels are staggered so that the sutures are staggered each other and not at the same level, which is conducive to the closure of the residual cavity with thickening of the muscle layers and the healing of the muscle breaks and the absorption of the oozing fluid. On the other hand, it is favorable for the healing of muscle breaks and the absorption of exudate. It can reduce the degree of thoracic deformity, reduce or avoid the formation of residual cavity and sinus tract and reduce the chance of incision non-healing. Drainage tubes are submerged in healthy muscle tissues, and can be used to drain out the fluid in the opposite direction of gravity when the patient is lying down or standing up, which can reduce or avoid the formation of sinus tracts after extubation. Negative-pressure drainage can make the exudates in the peripheral trauma cavities or potential trauma cavities centered around the drainage tubes drain out in time and minimize the chances of infections due to the existence of exudates, and at the same time the exudates in the trauma cavities are sucked out in time between the different levels of the trauma cavities and the different levels of the trauma cavities are easy to be attached and merged together. At the same time, the exudate between different tissue levels of the trauma cavity is sucked out in time, so that the different tissue levels of the trauma cavity are easy to stick together. In 5-7 days after the operation, the drainage fluid basically disappears and the chest wall is basically adherent between different levels, so the drainage tube can be removed. At the same time, the incision is changed, continue to use a thick cotton pad pressure bandage, two weeks when the sutures will be removed. Postoperative cotton pad pressure bandage for at least 3 weeks, regular anti-tuberculosis treatment for at least 6 months.