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Modified technique for thoracomyoplasty after posterolateral thoracotomy.

W Schreiner1, P Fuchs, R Autschbach

  • 1Department of Thoracic Surgery, Friedrich-Alexander-University, Erlangen, Germany. waldemar.schreiner@uk-erlangen.de

The Thoracic and Cardiovascular Surgeon
|March 25, 2010
PubMed
Summary

This study presents a novel four-muscle flap technique for thoracomyoplasty, offering an effective alternative for empyema space and bronchial stump insufficiency after prior thoracotomy. The modified approach utilizes shoulder girdle muscles, achieving acceptable results with minimal functional loss.

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Area of Science:

  • Thoracic Surgery
  • Surgical Innovation
  • Reconstructive Procedures

Background:

  • Posterolateral thoracotomy (PLT) can compromise latissimus dorsi muscle (LDM) vascularization, leading to atrophy and challenges in managing residual empyema or bronchial stump insufficiency.
  • Existing methods for thoracomyoplasty after PLT are often difficult due to reduced LDM mass.
  • Alternative surgical strategies are needed to effectively address these complex thoracic defects.

Purpose of the Study:

  • To introduce and evaluate a modified thoracomyoplasty technique using a four-muscle flap.
  • To assess the efficacy of this technique in filling residual empyema spaces and closing bronchial stump insufficiencies.
  • To determine the functional outcomes and complication rates associated with this novel approach.

Main Methods:

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  • A two-stage procedure involving open window thoracostomy followed by definitive surgery 3-6 months later was performed in 7 patients.
  • A four-muscle flap, including infraspinatus, subscapularis, and teres major muscle groups pedicled from the subscapular artery, was utilized.
  • The subscapularis muscle flap was specifically used to cover bronchial stumps in cases of insufficiency.

Main Results:

  • The study included 7 patients (mean age 68 years) with residual empyema, including post-tuberculosis and post-pneumectomy cases, with 3 involving bronchopleural fistulas.
  • Average time from open window thoracostomy to thoracomyoplasty was 4 months, with a mean hospital stay of 15 days.
  • No hospital mortality occurred; minor complications were seen in 2 patients, with shoulder abduction maintained up to 90 degrees with minimal functional decrease.

Conclusions:

  • Division of the LDM after PLT necessitates alternative muscle flaps for thoracomyoplasty.
  • Shoulder girdle muscles provide an adequate substitute for filling empyema spaces, yielding acceptable long-term results.
  • Pedicled subscapular muscle flaps are effective for bronchial stump closure in cases of fistula.