Muscle Flaps and Thoracomyoplasty as a Re-redo Procedure for Postoperative Empyema

The role of muscle flaps and thoracomyoplasty in the treatment of postoperative empyema is controversial. The major difficulty is given by the sectioning of the muscular masses during the previous thoracotomy/thoracotomies, resulting in a limitation of the volume and mobility of the available neighborhood flaps.

Between January 1, 2004, and January 1, 2012, we used muscle flaps and thoracomyoplasty as a re-redo procedure in seven patients having a history of at least two major procedures performed through thoracotomy (without considering tube thoracostomy and open thoracic window). In all the cases, the indication for thoracomyoplasty was the presence of an empyema which could not be controlled by the previous procedures. The principle of our procedure was to perform a complete obliteration of the cavity, closure reinforcement of the bronchial fistulae using muscle flaps (in four cases), drainage, and primary closure of the new operative wound.

We encountered no mortality, one bronchopneumonia requiring prolonged antibiotic treatment, and one intermuscular seroma; there was no need for prolonged mechanical ventilation or major inotropic support. In all the patients, we achieved complete obliteration of the cavity and per primam wound healing, with postoperative hospitalizations ranging between 30 and 51 days. At late follow-up (1-8 years), we encountered no recurrence and no major functional sequelae.

Thoracomyoplasty may be a definitive solution in cases with recurrent postoperative complications. A careful analysis of the local anatomy allows the use of muscle flaps even after more procedures involving opening of the chest.