[Thoracopleuromyoplasty as definitive cure for chronic pleural empyemas, after preparation by open thoracostomy]

Between 1979 and 1986, 30 patients with chronic pleural empyema (19 with pyothorax secondary to tuberculosis and 11 with pleural empyema following pulmonary resection) underwent two-stage treatment. The first stage consisted of open thoracostomy and was followed, 2 to 7 months later, by thoracopleuromyoplasty with latissimus dorsi, serratus anterior and pectoralis major muscles either alone or in combination. There was no operative mortality in this series of 30 operated patients. Definitive obliteraion of the pleural cavity and closure of the bronchial fistulae were obtained in 26 of the 30 patients. Partial necrosis of the muscle graft in the other 4 patients required further open drainage and an additional myoplasty. The long-term functional results in the cases of post-resection empyema were compatible with the restriction created by the pulmonary resection and, in the cases of empyema with a residual lung, with the restriction of the volume and perfusion of pulmonary parenchyma.