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Empyema complicating muscle-sparing thoracotomy: the role of wound management
David W Sees1, James A Obney, Henry F Tripp
1Division of Cardiothoracic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Abstract:
The fascial layers bordering the latissimus dorsi and anchoring the serratus muscles often do not lend themselves to impervious closure during muscle-sparing thoracotomy. Fluid from the subcutaneous space may therefore drain into the pleural cavity after such procedures. If this fluid is contaminated with microorganisms the potential for development of empyema is present. Two patients are presented in whom this scenario was presumed to have occurred. Early intervention in the second patient was felt to have avoided the development of a major empyema.
Insights
Muscle-sparing thoracotomy can lead to subcutaneous fluid draining into the pleural space, potentially causing empyema. Early intervention in one case may have prevented serious infection.
Area of Science:
- Thoracic Surgery
- Infectious Disease
Background:
- Muscle-sparing thoracotomy presents challenges in achieving watertight closure of fascial layers.
- Subcutaneous fluid accumulation and potential pleural space contamination are risks post-procedure.
Observation:
- Two cases are presented where subcutaneous fluid likely entered the pleural cavity.
- This fluid may be contaminated with microorganisms, increasing empyema risk.
- The fascial closure in muscle-sparing thoracotomy is often not impervious.
Findings:
- A potential pathway for subcutaneous fluid to enter the pleural space exists.
- Microbial contamination of this fluid can precipitate empyema development.
- Prompt intervention in one case appeared to avert a significant empyema.
Implications:
- Consideration of fascial closure techniques in muscle-sparing thoracotomy is important.
- Awareness of potential fluid drainage is crucial for preventing post-operative infections.
- Early recognition and management may mitigate severe empyema in at-risk patients.