Use of pedicled omental flap in treatment of empyema

Omental pedicle flaps were used in the treatment of patients with acute and chronic empyema with bronchopleural fistula. In 5 patients (group 1) with postoperative acute empyema owing to bronchial stump fistula, an omental covering was applied as a reinforcement to close the fistula. Six patients in group 2 with chronic tuberculous or Aspergillus empyema with multiple fistulas initially underwent open-window thoracostomy or cavernostomy and secondarily had omental transposition. In all patients, the right gastroepiploic vessels were used to provide the blood supply for the flap. Successful closure of the bronchial stump was obtained in all patients in group 1, but 2 of them died of recurrence of their underlying lung carcinoma within 1 year. Five of the 7 patients in group 2 had a favorable outcome, but 2 patients had partial recurrence after omental plombage. From our experience with these patients, we believe that the omental flap is effective for closing fistulas due to postoperative or chronic empyema but has only limited success in patients whose lungs are severely damaged by persistent infection.