Muscle Flaps and Thoracomyoplasty as a Re-redo Procedure for Postoperative Empyema

Botianu, Petre Vlah-Horea; Botianu, Alexandru M.; Bacârea, Vladimir

doi:10.1055/s-0034-1387820

Cited by 3 publications

(3 citation statements)

References 16 publications

(20 reference statements)

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“…According to Le Fourn (1994) the presence of a bronchial fistula which may be closed using an omental patch, previous radiotherapy and a large posterolateral thoracotomy with sectioning of the latissimus dorsi are arguments to preferr OP [30]. Since the OF does not have a very large volume, it is necessary in most cases to add the use of other muscle flaps and/or a thoracoplasty in order to achieve a complete obliteration of the infected space [31, 32]. To note that the OF is frequently used for both the closure of the bronchial fistula and filling of the empyema cavity, alone or together with other muscle flaps while many of the studies dedicated to the space-filling procedures for empyema include cases solved by OP without clearly explaining the reason why the omentum was preferred over other flaps [33–37].…”

Section: Reviewmentioning

confidence: 99%

Current indications for the intrathoracic transposition of the omentum

Botianu

2019

J Cardiothorac Surg

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Background The intrathoracic transposition of the omentum (ITO) has been reported with more or less good results in various clinical circumstances but with no clear guidelines or indications. Methodology and review This article reviews the main clinical situations in which omento-plasty (OP) may be taken into consideration by the thoracic surgeons: mediastinitis and deep sternal infections after median sternotomy, reinforcement of the eso-gastric anastomosis after esophagectomy, prevention and treatment of the bronchial fistula after pulmonary resection, space-filling procedures for empyema, mediastinal tracheostomy, management of the infected intrathoracic vascular grafts / ventricular assist devices and heart OP. For each clinical situation we have performed a literature review with analysis of the most relevant published papers searching for an evidence-based approach for the use of the ITO/OP in thoracic surgery. Conclusions OP may be an elegant solution for a wide range of problems in thoracic surgery. In the published literature, there are mainly case-reports and relatively small series published resulting in a low level of evidence for both ITO as a surgical technique by itself, as well as for the use of OP in various clinical situations involving the chest structures. The indications for its use in thoracic surgery are based more on common sense and the lack of other solutions.

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Section: Reviewmentioning

confidence: 99%

Current indications for the intrathoracic transposition of the omentum

Botianu

2019

J Cardiothorac Surg

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“…Препараты, разработанные на основе аутологичных компонентов, все шире внедряются в косметологию и травматологию, однако в торакальной хирургии биотехнологии на основе PRP-технологий до настоящего времени не нашли применения, что и обусловливает актуальность данной работы. По-прежнему нерешенными проблемами остается стабилизация реберного каркаса при тяжелых сочетанных травмах и ликвидация остаточных полостей при хронических эмпиемах плевры, что требует поиска новых решений с применением биологической стимуляции адгезиогенеза в комплексном лечении данных нозологий [4][5][6][7]. ЦЕЛЬ РАБОТЫ -определение эффективности применения плазмы, обогащенной тромбоцитами, в комплексном лечении травмы грудной клетки и эмпиемы плевры.…”

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Complex Biostimulation of Intrapleural Adhesiogenesis in Thoracal Surgery

Калашніков

Воробьев

Kalashnikova

et al. 2020

Farm. farmakol. (Pâtigorsk)

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The aim of the study is to determine the effectiveness of the use of platelet enriched plasma in the complex treatment of chest trauma and chronic pleural empyema.Materials and methods. The work was performed on 450 male rats, simulated with chest trauma (n=180) and chronic pleural empyema (n=270). In the experimental groups, biostimulation of adhesiogenesis as an intrapleural injection of 1 ml of platelet-enriched plasma was carried out; in the comparison group; the animals with pleural empyema were injected with 1 ml of doxycycline solution; in the negative control groups, the treatment was not carried out at all. Withdrawal from the experiment took place on the 10th, 20th, 30th days. The samples of intrapleural adhesions were fixed in 10% formalin, followed by histological tracing and preparation of micropreparations, staining with hematoxylin and eosin. The morphometric study included determination of the volume fraction (VF) of collagen and reticular fibers; fibrin; inflammatory cells; blood-stream (%).Results. An intrapleural administration of platelet-rich plasma is an effective way to stabilize the rib cage in chest injuries, and to eliminate residual cavities in chronic pleural empyema. When assessing the severity of the adhesions in chest trauma, it was found out that adhesions are most often visualized at the sites of rib fractures (from 13.3 to 40%). In pleural empyema, during the entire process of observation, the VF of collagen fibers forming adhesions was higher in the group with biological stimulation of adhesiogenesis than in the NCpe group and in the CG. In the PRP group, already at the initial stages of the experiment, this indicator was significantly lower than in the NC and CG (p<0.05).Conclusion. Based on the data obtained, the effectiveness of the use of platelet-enriched plasma in thoracic surgery for the biological potentiation of adhesiogenesis has been proved in experimental chest injuries and chronic pleural empyema.

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“…Для заполнения экстраплевральных полостей после резекции отрезков ребер и экстроплеврального пневмолиза применяют жидкости, мышечный лоскут на ножке, сальник, пломбировочный коллагеновый материал или используются пломбажные шары [28][29][30][31][32][33][34]. Некоторые авторы выполняют компрессию остаточными фрагментами ребер или ключицы с помощью металлической пластины или композитных материалов [35,36].…”

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Application of transplants in collapse surgery in patients with lung tuberculosis

Белов

2020

Tihookeanskij medicinskij žurnal

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Russia is one of the countries with high incidence rate of pulmonary tuberculosis. The existence of Mycobacterium tuberculosis under the persistent antibacterial therapy effect leads to a formation of drug resistant forms especially in immunodeficiency in persons with HIV-infection, the number of which is increasing every year. The use of combination of different types of collapse surgery in order to maintain a larger volume of normal pulmonary tissue enables to increase the number of cured patients. The results of literature review show a development and improvement of collapse surgery techniques. The application of different methods of compression of the affected part of the lung, collapse of destruction cavity and fixing the lung in a collapsed state are presented. The main reason for use of transplants in pulmonary tuberculosis collapse surgery is to create conditions for reparation and increase of efficacy of surgical treatment for destructive forms of pulmonary tuberculosis in cases in which for one reason or another it is impossible to perform a respective surgical operation.

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Muscle Flaps and Thoracomyoplasty as a Re-redo Procedure for Postoperative Empyema

Abstract: Thoracomyoplasty may be a definitive solution in cases with recurrent postoperative complications. A careful analysis of the local anatomy allows the use of muscle flaps even after more procedures involving opening of the chest.

Cited by 3 publications

References 16 publications

Current indications for the intrathoracic transposition of the omentum

Current indications for the intrathoracic transposition of the omentum

Complex Biostimulation of Intrapleural Adhesiogenesis in Thoracal Surgery

Application of transplants in collapse surgery in patients with lung tuberculosis

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