Thorac Cardiovasc Surg 2013; 61(02): 167-171
DOI: 10.1055/s-0032-1311552
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Intrathoracic Muscular Transposition in Chronic Tuberculous Empyema

Hyo Yeong Ahn
1   Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
,
Jeong Su Cho
1   Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
,
Yeong Dae Kim
1   Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
,
I. Hoseok
1   Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
› Author Affiliations
Further Information

Publication History

22 January 2012

05 March 2012

Publication Date:
22 June 2012 (online)

Abstract

Background The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable.

Methods From June 1999 to July 2010, 18 patients with chronic tuberculous empyema who underwent OWT and/or IMT were enrolled in this study. The causes of empyema, and methods and outcomes of treatment were retrospectively reviewed. The success rate of IMT was investigated to evaluate the efficacy.

Results Mean patient age was 54.3 ± 14.9 years and 16 patients were male. Depending on operative methods, three groups were divided: OWT only (n = 4); two-stage operation as OWT followed by IMT (n = 7); and one-stage operation as OWT with IMT simultaneously (n = 7). Of 14 patients who underwent IMT, 13 patients successfully recovered from empyema and bronchopleural fistula (BPF) (success rate, 92.86%), but one patient developed a secondary bacterial infection. There was no operative mortality.

Conclusion This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.

 
  • Reference

  • 1 Glicklich M, Mendelson DS, Gendal ES, Teirstein AS. Tuberculous empyema necessitatis. Computed tomography findings. Clin Imaging 1990; 14 (1) 23-25
  • 2 Mancini P, Mazzei L, Zarzana A, Biagioli D, Sposato B, Croce GF. Post-tuberculosis chronic empyema of the “forty years after”. Eur Rev Med Pharmacol Sci 1998; 2 (1) 25-29
  • 3 Eloesser L. An operation for tuberculous empyema. Chest 2009; 136 (5 Suppl) e30-
  • 4 Sabirov ShIu. Surgical treatment for destructive pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema. Probl Tuberk Bolezn Legk 2009; 8 (8) 31-33
  • 5 Feola GP, Shaw LC, Coburn L. Management of complicated parapneumonic effusions in children. Tech Vasc Interv Radiol 2003; 6 (4) 197-204
  • 6 Maruyama R, Ondo K, Mikami K, Ueda H, Motohiro A. Clinical course and management of patients undergoing open window thoracostomy for thoracic empyema. Respiration 2001; 68 (6) 606-610
  • 7 Sahn SA. Management of complicated parapneumonic effusions. Am Rev Respir Dis 1993; 148 (3) 813-817
  • 8 García-Yuste M, Ramos G, Duque JL , et al. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg 1998; 65 (3) 818-822
  • 9 Arnold PG, Pairolero PC. Intrathoracic muscle flaps. An account of their use in the management of 100 consecutive patients. Ann Surg 1990; 211 (6) 656-660 , discussion 660–662
  • 10 Krassas A, Grima R, Bagan P , et al. Current indications and results for thoracoplasty and intrathoracic muscle transposition. Eur J Cardiothorac Surg 2010; 37 (5) 1215-1220
  • 11 Regnard JF, Alifano M, Puyo P, Fares E, Magdeleinat P, Levasseur P. Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection. J Thorac Cardiovasc Surg 2000; 120 (2) 270-275
  • 12 Clagett OT, Geraci JE. A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 1963; 45: 141-145
  • 13 Seify H, Mansour K, Miller J , et al. Single-stage muscle flap reconstruction of the postpneumonectomy empyema space: the Emory experience. Plast Reconstr Surg 2007; 120 (7) 1886-1891
  • 14 Walsh MD, Bruno AD, Onaitis MW , et al. The role of intrathoracic free flaps for chronic empyema. Ann Thorac Surg 2011; 91 (3) 865-868
  • 15 Fell SC, Mollenkopf FP, Montefusco CM , et al. Revascularization of ischemic bronchial anastomoses by an intercostal pedicle flap. J Thorac Cardiovasc Surg 1985; 90 (2) 172-178
  • 16 Stafford EG, Clagett OT. Postpneumonectomy emphema. Neomycin instillation and definitive closure. J Thorac Cardiovasc Surg 1972; 63 (5) 771-775
  • 17 Virkkula L, Eerola S. Treatment of postpneumonectomy empyema. Scand J Thorac Cardiovasc Surg 1974; 8 (2) 133-137