Application of pedicle combined muscle flaps in treatment of chronic empyema with huge irregular abscess cavity after pulmonary surgery: a case report and literature review

Abstract

Background Chronic empyema is usually considered to be very challenging in clinical management and has a high mortality rate. On this basis, if combined with bronchopleural fistula (BPF) and huge irregular abscess cavity, there are not many treatment options available, and some patients may even develop cachexia due to long-term chronic consumption. The application of pedicled combined muscle flaps to repair and reconstruct according to the region of abscess cavity may improve the quality of life for such complex cases. Case presentation A 59-year-old male patient underwent surgical treatment for lung squamous cell carcinoma 2 years ago. Due to the low differentiation of malignant tumor, empyema complicated with BPF occurred after the fourth cycle of chemotherapy. His past medical history was free of other illnesses. The patient was admitted to our hospital for further treatment because of long-term chest tube drainage and obvious respiratory irritation symptoms such as cough during body position change. Chest computed tomography (CT) scan revealed a left-sided hydropneumothorax. Bronchoscopy revealed BPF. Considering that the volume of the abscess cavity did not shrink significantly after long-term drainage, we chose first-stage surgery to complete the debridement of empyema and the closure of the fistula. In the second-stage surgery, the combined pedicled muscle flaps were used to complete the filling in different areas of the huge irregular residual cavity. This surgical mode of staging and sub-regional treatment of abscess cavity has achieved satisfactory clinical results. Conclusions Utilizing the pedicled combined muscle flaps to address chronic empyema accompanied by a huge irregular abscess cavity shows promise as a treatment method for eliminating residual cavity in various regions.