Single stage complete muscle flap closure of the ...



Single stage complete muscle flap closure of the postpneumonectomy empyema space.

Hisham Seify M.D, Joseph, Miller M.D, Kamal Mansour M.D

From the Joseph B. Whitehead Department of Surgery, Division of Plastic surgery, Emory University School Of Medicine, Atlanta, GA

Introduction:

The management of postpneumonectomy empyema remains a challenge in the field of thoracic surgery. It is an uncommon but disturbing complication. Several methods have been described historically ranging from rib resection to complete thoracoplaty, and tissue transfer. Because of the excellent blood supply of Extrathoracic muscle flaps and their ability to reach any place in the pleural cavity, they represent an ideal tissue to fill a contaminated space.

Material and methods:

Twenty two patients with postpneumonectomy empyema underwent muscle flap transposition +/- thoracoplasty for coverage of the postpneumonectomy stump.

Data cards were filled for each patient, delineating age, sex, diagnosis, type of procedure performed as well as any complications.

Results:

Twenty-two patients underwent single stage muscle closure of the pneumonectomy space with extrathoracic muscle flaps and omental grafts. Thirteen Men and nine women, ranging from 43 years to 77 years underwent such a closure. Nine patients had associated bronchopleural fistula. All operations were single stage and all wounds were closed primarly. One patient had a partial necrosis of a rectus muscle flap used to close the left chest, which was debrided and a local advancement flap was used for closure. Another patient had a seroma following a Latissimus muscle transfer , which was aspirated.

All other patient had viable flaps with closure of the pneumonectomy space.

Conclusion:

Management of postpneumonectomy empyema remains a difficult challenge for the thoracic and reconstructive surgeon. The introduction of extrathoracic muscle flap transfer for covering the pneumonectomy stump proved to be an excellent solution to this difficult problem.

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