Surgical results for chronic empyema using omental pedicled flap: long-term follow-up study

Successful treatment of chronic empyema remains a challenge for thoracic surgeons. Herein, we report our 17 years of experience with the omental pedicled flap procedure for management of chronic empyema secondary to pulmonary tuberculosis.

We retrospectively reviewed the surgical results of 23 patients who underwent surgical treatment for chronic empyema using an omental pedicled flap from 1987 to 2003.

The subjects were 20 men and 3 women (mean age, 58.1 years) with average % vital capacity (VC) and forced expiratory volume in 1 second (FEV1) values of 48.1% and 1.19 L, respectively. Sixteen patients (69.6%) had bronchopleural fistulas and 21 (91.3%) were associated with infection by causative organisms (6 Aspergillus organisms, 4 methicillin-resistant Staphylococcus aureus, 10 others). An open window thoracostomy preceded in 17 patients (72.9%). Eleven patients were treated using an omental pedicled flap with or without a muscle flap, and 12 were treated using an omental pedicled flap with a partial thoracoplasty. There was 1 operation-related death, and clinical success was achieved in 19 patients (82.6%), in whom pulmonary function did not decrease significantly. During long-term follow-up, 5 patients died of respiratory failure, and their mean postoperative %VC and FEV1 values were 30.1% and 0.76 L, respectively.

We concluded that the use of an omental pedicled flap for chronic empyema was effective even in cases with active infection, and did not compromise pulmonary function. Further, an additional thoracoplasty may completely obliterate the dead space, although indications should be referenced to preoperative pulmonary function.