Muscle flaps and thoracomyoplasty: alternative solution for unresectable primary pulmonary abscesses

The objective of this study is to perform a retrospective analysis of our experience in using muscle flaps and thoracomyoplasty for unresectable primary pulmonary abscesses.

Between January 1, 2003, and January 1, 2012, we have used different muscle flaps and thoracomyoplasty in 15 patients with unresectable primary pulmonary abscesses. Muscle transposition was used alone (3 cases) or during thoracomyoplasty procedures for lung abscesses complicated with empyema (12 cases). The objective of the procedure was complete obliteration of the diseased space, with additional limited thoracoplasty being required in 12 out of 15 patients (average resected ribs: 3.7); bronchial fistula were encountered in 9 patients and were closed-reinforced using muscle flaps. The following parameters were followed: mortality, morbidity, intensive care and overall postoperative hospitalization, recurrence, and late sequelae.

We have encountered one postoperative death (6.7%) and an overall 46.7% morbidity. Intensive-care unit stay ranged between 1 and 5 days with a median of 2. Overall postoperative hospitalization ranged between 22 and 46 days, with a median of 32 days. At late 1-year follow-up, we encountered no recurrence and no major chest deformity with a moderate limitation of shoulder mobility in two patients.

Space-filling procedures are a valuable solution for unresectable primary pulmonary abscesses, allowing the avoidance of open drainage and pleuropneumonectomy. The extensive mobilization of the flaps offers a good-quality biological material with considerable volume.