Introduction :

Despite continued improvement in medical therapy , post-surgical empyema remains a potentially lethal problem. Multi treatment options are available, however, the optimal therapeutic management has not been elucidated.

Material and methods :

Retrospective study of 55 patients requiring different treatment modalities, including muscle flap transposition. Data cards were filled retrospectively for each patient indicating : age, sex, diagnosis, procedures performed , period of hospitalization as well as complications and outcome. We divided the patients into 4 groups: Group A : Non-resectional . Group B : Post-pneumonectomy. Group C : Post-lobectomy. Group D : Prophylactic post-resectional.

Results:

A total of 42 flaps were used in 23 patients ( average 1.8 flap per patient).Two patients developed persistent empyema(8.7%). Sixty procedures were performed in 55 patients(including open window thoracostomy and debridment). Average time from initial thoracic operation to flap intervention was 4 month. Average time from flap intervention to discharge was 12.5 days. Average hospital stay was 26.6 days.

Discussion :

Empyema occurs in 1-11 % following standard pneumonectomy. Mortality 11-13%. Classic approach requires surgical drainage ,debridment , and open pleural packing or antibiotics fluid irrigation. (75-88%) success rate initially. Muscle flaps provides excellent blood supply, extended reach. Flap closure is achieved in 3-6 month . Following transposition :wound closed primarily with CT for 7-10 days. The Sine qua non for success is complete space obliteration, absence of tension.

Conclusion :

In this study 23 patients with post-resectional empyema were managed with single stage muscle flap closure. Two patients developed persistent empyema requiring other procedures.(8.7 % failure rate). Principles of dealing with an empyema space remains the same: Drainage, sterilization, space obliteration with antibiotics or vascularized tissue.
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