Operative treatment of postpulmonectomy empyema

To analyse retrospectively 10 patients with postpulmonectomy empyema.

Ten patients (9 men, 1 woman, aged 48 to 69 years) with postpulmonectomy empyema treated over a 12 year period (1991--2002) were analysed. Nine of the patients had pulmonectomy for lung carcinoma and one--for pulmonary abscess. All postpulmonectomy empyemas were managed in two stages--an open-window thoracostomy for curing the infective process in the empyema cavity and then closure of the bronchopleural fistulas and obliteration of the cavity. Video-assisted thoracoscopy (VATS) was successfully used by the authors for sterilization and debridement of the cavity, and finally to insert two thoracic drains for the cavity lavage. The obliteration of the empyema cavity was achieved by a vascular muscle flap transposition from the thoracic muscles. The latissimus dorsi muscle flap was used in 6 patients. The pectoralis major muscle flap was used in 4 patients. Additionally, a thoracoplasty was performed in the patients with pectoralis major muscle flap transposition.

Eight patients (80%) were discharged from hospital without complications, and two patients died (20%).

On the basis of the study results and the literature review the authors conclude that the applied therapy yields good results in the treatment of postpulmonectomy empyema.