Purpose Statement: The purpose of this study is to examine our series of 5 intra-thoracic free flaps in four patients for treatment of persistent bronchopleural fistula and chronic empyema space.

Material and Methods: We conducted a chart review from 1996-2006 of all patients receiving intra-thoracic free flaps for the treatment of persistent bronchopleural fistula and chronic empyema space. We looked at indications, etiology, previous surgeries, choice of free flap, recipient vessels, length of hospital stay, follow up, and complications.

Summary of Results: Four patients were identified. One patient underwent two separate free flap procedures. Indications were persistent bronchpleural fistula(n=4) and chronic empyema space(n=5). Etiology of the bronchopleural fistulas and chronic empyema spaces were lung cancer (n=2), penetrating trauma (n=2), pneumonia (n=1). Two rectus abdominus, one TRAM, and 2 gracilis free flaps were performed. Hospital stay was 6.6 days (5-9 days). Follow up was 29 months (4mos to 5years). There was no flap loss and no recurrent bronchoplueral fistula.

Conclusions: Chronic empyema space and persistent bronchopleural fistula are difficult problems to manage. Intra-thoracic free flaps can be used to successfully treat persistent broncho-pleural fistula and chronic empyema space in patients whose local flap options are non-useable.