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Cardiothoracic Surgery |

Muscle Flaps for Postoperative Empyema - Possibilities and Limitations

Petre Vlah-Horea Botianu*, MD; Alexandru-Mihail Botianu, MD
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University of Medicine and Pharmacy, Tirgu-Mures, Romania


Chest. 2012;142(4_MeetingAbstracts):60A. doi:10.1378/chest.1389976
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Abstract

SESSION TYPE: Thoracic Surgery Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The aim of this study is to evaluate the possibilities and limitations of using muscle flaps for postoperative empyema after major thoracic procedures.

METHODS: Between 01.01.2003-01.01.2011 we used muscle flaps during major reoperations in 26 cases of postoperative empyema. The primary procedure was decortication - 14 cases (alone in 4 cases, associated with other procedures in 10 cases), pneumonectomy - 4 cases, lobectomy - 4 cases, non-anatomic resection - 5 cases and thoracoplasty - 1 case. The flaps were chosen according to the anatomy of the empyema and availability after the previous thoracotomy. In order to achieve complete obliteration we associated a topographic rib resection-ranges 1-6, with an average of 3,6/patient.

RESULTS: The following extrathoracic muscle flaps were used: serratus anterior 24 cases, latissimus dorsi 18 cases, pectorals - 9 cases, subscapularis - 4 cases, omentum - 1 case; intercostal flaps were also used in all cases. We encountered 1 postoperative death (4%). Local complications included empyema recurrence - 2 cases, tumoral recurrence - 1 case and minor skin necrosis - 1 case; we encountered no flap necrosis. Intensive care unit stay ranged between 1-9 days, with a median of 2 days and overall postoperative hospitalisation ranged between 8-87 days, with a median of 36 days. At late follow-up, we encountered in 4 patients (15%) a minor limitation of the shoulder mobility.

CONCLUSIONS: The use of the neighbourhood muscle flaps is always possible if major surgery for postoperative empyema is required. The main limitation is the damage resulted from the previous thoracotomy, making an associated limited thoracoplasty frequently necessary.

CLINICAL IMPLICATIONS: Muscle flaps are usefull in cases of postoperative empyema. Thoracic surgeons should be familiar with the techniques of mobilization and intrathoracic transposition of the muscle flaps.

DISCLOSURE: The following authors have nothing to disclose: Petre Vlah-Horea Botianu, Alexandru-Mihail Botianu

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University of Medicine and Pharmacy, Tirgu-Mures, Romania

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