Free musculocutaneous flap transfer for refractory chronic empyema with chest wall sinus in a 43-year-old male with hemophilia A

He, Xiaowen; He, Zhongliang; Shen, Lifeng; Chen, Guoxing; He, Xueming

doi:10.21037/jtd.2018.05.201

Cited by 10 publications

(13 citation statements)

References 10 publications

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“…However, elderly patients with a large pleural cavity or those who are unsuitable for receiving a free muscle flap could have 2 or more combined pedicled muscle flaps transferred simultaneously to obliterate the pleural cavity, like in the case of our patient (9). When a pedicled muscle flap cannot be used, a free musculocutaneous flap harvested from a vastus lateralis or rectus abdominis can be transposed to completely obliterate the cavity (10).…”

Section: Discussionmentioning

confidence: 99%

An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report

Shen

et al. 2021

Ann Transl Med

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Bronchopleural fistula (BPF) with empyema is a severe complication in patients undergoing lobectomy or pneumonectomy and is associated with high morbidity and mortality rates. Although a wide variety of treatment options exist, refractory cases with larger fistulas are still difficult to cure, especially in elderly patients. Here, we report a case of an 83-year-old man with stage I squamous cell lung carcinoma who underwent minimally invasive right lower lobectomy. After an initially uneventful postoperative course, he was readmitted to our hospital due to the progression of severe cough with fever after lung resection. Chest computed tomography (CT) showed an empyema cavity containing pleural effusion and a drainage tube in the right lower thorax. Bronchoscopy confirmed the presence of a fistula between the right lower bronchial stump and the pleural cavity. On the basis of his clinical symptoms and these imaging findings, the patient was diagnosed with BPF with empyema after lobectomy. He was successfully treated with multidisciplinary management including adequate pleural drainage by open-window thoracostomy, closure of the BPF by endoscopic therapy using an Amplatzer device, and complete obliteration of the empyema cavity with pedicled muscle flap. Multidisciplinary management combining thoracostomy, endoscopic therapy, and pedicled muscle flap transfer is a safe and effective treatment for elderly patients with larger fistulas and empyema.

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Section: Discussionmentioning

confidence: 99%

An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report

Shen

et al. 2021

Ann Transl Med

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“…In this case, we selected the free vastus lateralis musculocutaneous ap and pedicled pectoralis major myocutaneous ap for treatment. Compared with other free myocutaneous aps, this combined myocutaneous aps have the advantage of convenient anatomy, easy access, large volume and rich muscle tissue, which can meet the requirements of lling huge cavities, it can enrich the vascular anastomosis between donor and recipient (11,12).…”

Section: Discussionmentioning

confidence: 99%

Salvage Treatment of Acute Respiratory Failure after Transcomposite Myocutaneous Flaps Transplantation for Chronic Empyema Combined with Chest Wall Sinus: A Case Report

Wang

2021

Preprint

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BackgroundChronic empyema with chest wall sinus is a complex and refractory disease caused by multiple factors.It may be combined with bronchopleural fistula, residual bone and other necrotic tissue,causing local infection difficult to control, and the disease is a vicious circle.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 11 years ago and began to develop empyema with purulent sinus in the anterior chest wall 3 years ago. Therefore, he was admitted to our medical center for further treatment. Chest computed tomography (CT) showed the right pleural effusion with the chest wall rupture sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the large empyema cavity,the patient should be treated with free vastus lateralis musculocutaneous flap combined with pedicled pectoralis major muscle flap transplantation.After the operation, acute respiratory failure occurred due to left lung aspiration pneumonia.ConclusionsAfter a series of treatment measures such as tracheal intubation, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, he was finally rescued and cured.Follow-up after discharge showed that the tissue flap survived and empyema was eliminated.

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“…[ 12 ] In some cases, when pedicled muscle flap was not able to be used, a free musculocutaneous flap, such as a rectus abdominis flap, or a vastus lateralis flap, was harvested and/or the greater omentum was used, either alone or in combination. [ 13 – 15 ]…”

Section: Discussionmentioning

confidence: 99%

Effective treatment of bronchopleural fistula with empyema by pedicled latissimus dorsi muscle flap transfer

He¹,

Shen²,

et al. 2020

Medicine

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Rationale: Bronchopleural fistula (BPF) is a dreaded complication after lobectomy or pneumonectomy and is associated with high morbidity and mortality. Successful management remains challenging when this condition is combined with empyema, and the initial treatment is usually conservative and endoscopic, but operative intervention may be required in refractory cases. Patient concerns: Two patients diagnosed with BPF with empyema were selected to undergo surgery in our hospital because they could not be cured by conservative and endoscopic therapy for 1 or more years. One was a 70-year-old man who had a 1-year history of fever and cough after he received a minimally invasive right lower lobectomy for intermediate lung adenocarcinoma and chemotherapy 2 years ago; the other was a 73-year-old man who had a 2-year history of cough and fever after he underwent a minimally invasive right upper lobectomy for early lung adenocarcinoma 3 years earlier. Diagnosis: Both patients were diagnosed with BPF with empyema. Interventions: After receiving conservative and endoscopic therapies, both patients underwent pedicled latissimus dorsi muscle flap transfers for complete filling of the empyema cavity. Outcomes: The patients recovered very well, with no recurrence of BPF and empyema during postoperative follow-up. Lessons: It is crucial to not only completely control infection and occlude BPFs, but also obliterate the empyema cavity. Thus, pedicled latissimus dorsi muscle flap transfer associated with conservative and endoscopic therapies for BPF with empyema is a useful treatment option, offering feasible and efficient management with promising results.

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Free musculocutaneous flap transfer for refractory chronic empyema with chest wall sinus in a 43-year-old male with hemophilia A

Abstract: He et al. Free musculocutaneous flap transfer in a patient with hemophilia A Cite this article as: He X, He Z, Shen L, Chen G, He X. Free musculocutaneous flap transfer for refractory chronic empyema with chest wall sinus in a 43-year-old male with hemophilia A.

Cited by 10 publications

References 10 publications

An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report

An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report

Salvage Treatment of Acute Respiratory Failure after Transcomposite Myocutaneous Flaps Transplantation for Chronic Empyema Combined with Chest Wall Sinus: A Case Report

Effective treatment of bronchopleural fistula with empyema by pedicled latissimus dorsi muscle flap transfer

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