Intrathoracic transposition of extrathoracic skeletal muscle

During the past 6 years, 31 patients (20 males and 11 females) underwent 45 intrathoracic muscle transpositions of extrathoracic skeletal muscle. Eleven patients had postpneumonectomy empyema, 11 had bronchopleural fistula, four had infection of the heart and great vessels, three had reinforcement of tracheal anastomoses, and two had perforation of the gastrointestinal tract. Life-threatening infection was present in 28 patients. Ages ranged from 16 to 80 years, with a mean of 58.1. The latissimus dorsi muscle was transposed in 18 patients, pectoralis major muscle in 15, serratus anterior muscle in eight, pectoralis minor muscle in three, and rectus abdominis muscle in one. Twelve patients had multiple muscle transpositions (six concurrently and six staged). Operative mortality was 12.9% (four patients). Follow-up of the 27 operative survivors ranged from 3 to 72 months with a mean of 17.3. Twenty-four patients had no further signs or symptoms of the original infection. All had a closed chest. Long-term survivors included 73% of patients with postpneumonectomy empyema, 64% of patients with bronchopleural fistulas, and 50% of patients with infections of the heart and great vessels. We conclude that intrathoracic transposition of an extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infection.