Surgical management of children with pyopneumothorax: serratus anterior digitation flap

Area of Science:

• Pediatric surgery
• Thoracic surgery
• Infectious diseases

Background:

• Spontaneous bronchopleural fistula following childhood empyema is a rare but serious complication.
• This condition presents significant surgical challenges and is linked to high patient morbidity.

Observation:

• The study reports on four children diagnosed with pyopneumothorax and concurrent spontaneous infective bronchopleural fistula.
• These cases highlight the complex nature of post-empyema thoracic complications in pediatric patients.

Findings:

• A thoracotomy for empyema drainage combined with limited decortication was performed.
• A successful outcome was achieved by suturing a raised serratus anterior digitation flap around the fistula.

Implications:

• This case series introduces and describes a potentially effective surgical technique for managing spontaneous bronchopleural fistulas in children.
• The serratus anterior digitation flap offers a viable reconstructive option, potentially improving outcomes for this challenging condition.