Tailored Thoracomyoplasty as a Valid Treatment Option for Chronic Postlobectomy Empyema

Abstract

Background: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients ( 11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Resu!ts:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEY l of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy. Conclusions AbstractBackground: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients (11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). ln 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Results:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEVI of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scolios...

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

“…2,6 In postoperative empyema, it is usually used as a second major procedure after the initial thoracotomy if other conservative treatments fail. [7][8][9] In the available literature, we did not find any study focusing on the use of thoracomyoplasty as a re-redo procedure after at least two other major procedures. Thoracomyoplasty is now an acceptable solution for patients with intrathoracic suppurations which cannot be solved by other less-invasive procedures, including postoperative empyema.…”

“…The main limitation of thoracomyoplasty in the particular situation of postoperative empyema is the previous sectioning of the muscles, which limits their availability and degree of mobilization. 8,9 The treatment of most of these patients (both surgical and antibiotic therapy, as well as some diagnostic approaches, i.e., pleural cultures and biopsy to confirm TB) was not made according to the current state of the art. This less-than-ideal approach has a certain role in this extremely complicated course of the patients.…”

Thoracomyoplasty for Chronic Empyema and Osteoradionecrosis of the Chest Wall

“…Post-pulmonary resection empyema is a challenging condition to manage. The incidence of a residual space after lobectomy at discharge ranges from 5% to 21%, and infection develops in approximately 2% of these patients [ 1 ]. The incidence of postpneumonectomy empyema (PPE) varies from 2.2% to 16%, and the mortality rate of PPE is high if it is associated with a fistula [ 2 ].…”

Muscle flaps in pulmonary infections: a case series from Northeast India

“…The success rate of thoracomyoplasty ranges from 94% to 100% for treatment of empyema. [14][15][16] The timing of such combined procedures is of great importance. We believe that space obliteration should be performed as soon as the objectives of thoracostomy and infection control are achieved.…”