Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

Abstract

Background: Open window thoracotomy (OWT) as well as its closure are challenging. Transposition of omental pedicle and muscle flaps is often performed for OWT closure; however, the better technique among the two is unknown. The purpose of this series was to evaluate the outcomes of using both omental pedicle and muscle flaps for the aforementioned closure. Results: There were 9 (33.3%) omental pedicle flap procedures and 18 (66.7%) muscle flap procedures.The rate of local recurrence after closure of OWT was significantly higher with muscle flap than with omental pedicle flap (0% vs. 50.0%, P=0.012). The median duration of postoperative hospital stay was significantly shorter with omental pedicle flap than that with muscle flap (16.0 vs. 41.5 days, P=0.037).Mortality was observed in 2 patients (11.2%) in the muscle flap group and no patient in the omental pedicle flap group. Success rate was similar between the two groups (100% for omental pedicle flap vs. 83.3% for muscle flap).Conclusions: Omental pedicle flap was superior to muscle flap in terms of reducing local recurrence and shortening postoperative hospital stay. However, mortality, morbidity and success rates were not affected by the choice of flap.

The omentum flap for empyema treatment: indications and disadvantages

“…This is in relation to the statement of Shinohara et al that "omental pedicle flap for OWT closure is the most radical surgical treatment for thoracic empyema and is used for very severe cases" (1).…”

“…In this sense the OWT is one of the last resorts of adequate drainage and decreasing the infection of the empyema and not infrequently in these cases a flap is needed for the obliteration of the empyema cavity (2). Following all these principles Shinohara et al achieved remarkable results to our opinion (1).…”

“…Dear Sirs, We read with great interest the article of Shinohara et al "Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy "in which they compare the muscle and omentum flaps (1). The authors compare the omentum pedicle flap with the loco-regional muscle flaps for the treatment of empyema.…”

“…The authors compare the omentum pedicle flap with the loco-regional muscle flaps for the treatment of empyema. They conclude that the omentum is superior in reducing local recurrence and shortening postoperative hospital stay after openwindow thoracostomy (OWT) closure with mortality, morbidity and success rates remaining the same in both groups (1).…”

Flap choice for closure of open window thoracotomy: a response to the author of the article entitled “the omentum flap for empyema treatment: indications and disadvantages”

“…However, flap choice is difficult and controversial. We reported the outcomes of using the omental pedicle and muscle flaps for OWT closure (1) and concluded that the omental pedicle flap was superior to the muscle flap in terms of fewer local recurrence and shorter hospital stay, although rates of success and mortality were equal.…”