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DOI: 10.1055/s-0028-1104549
Tissue Plug Technique for Management of Large Chronic Empyema Defects and Bronchopleural Fistulas
Publication History
Publication Date:
02 January 2009 (online)
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ABSTRACT
After multiple thoracotomies, local muscles are often transected or sacrificed for the treatment of intrathoracic infection. In these conditions, free tissue transfers are described as an alternative. Five anterolateral thigh musculocutaneous free flaps were used for the treatment of complicated large chronic empyema defects and bronchopleural fistulas with a special flap inset and gauze-packing method, the so-called tissue plug technique. All flaps survived completely without complication. There was no sign of recurrent infection, and the bronchopleural fistulas were sealed and the empyema cavities completely obliterated. We concluded that the tissue plug technique is an alternative for the management of difficult empyema cavities and bronchopleural fistulas in selected patients where the soft tissue flap is not enough to fill the complete dead spaces.
KEYWORDS
Chronic empyema - free soft tissue transfer - tissue plug technique
REFERENCES
- 1 Hankins J R, Miller J E, McLaughlin J S. The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients. Ann Thorac Surg. 1978; 25 491-499
- 2 Pairolero P C, Arnold P G, Piehler J M. Intrathoracic transposition of extrathoracic skeletal muscle. J Thorac Cardiovasc Surg. 1983; 86 809-817
- 3 Tobin G R, Mavroudis C, Howe W R et al.. Reconstruction of complex thoracic defects with myocutaneous and muscle flaps: applications of new flap refinements. J Thorac Cardiovasc Surg. 1983; 85 219-228
- 4 Miller J I, Mansour K A, Nahai F et al.. Single stage complete muscle flap closure of the postpneumonectomy empyema space: a new method and possible solution to a disturbing complication. Ann Thorac Surg. 1984; 38 227-231
- 5 Arnold P G, Pairolero P C. Intrathoracic muscle flaps: a 10-year experience in the management of life threatening infections. Plast Reconstr Surg. 1989; 84 92-99
- 6 Arnold P G, Pairolero P C. Intrathoracic muscle flaps: an account of their use in the management of 100 consecutive patients. Ann Surg. 1990; 211 656-660
- 7 Hammond D C, Fisher J, Meland N B. Intrathoracic free flaps. Plast Reconstr Surg. 1993; 91 1259-1264
- 8 Al-Kattan K M, Breach N M, Kaplan D K et al.. Soft tissue reconstruction in thoracic surgery. Ann Thorac Surg. 1995; 60 1372-1375
- 9 Chen H C, Tang Y B, Noordhoff M S et al.. Microvascular free muscle flaps for chronic empyema with bronchopleural fistula when the major local muscles have been divided. One stage operation with primary wound closure. Ann Plast Surg. 1990; 24 510-516
- 10 Perkins D J, Lee K K, Pennington D G et al.. Free flaps in the management of intrathoracic sepsis. Br J Plast Surg. 1995; 48 546-550
- 11 Chen H C, Santamaria E, Chen H H et al.. Microvascular vastus lateralis muscle flap for chronic empyema associated with a large cavity. Ann Thorac Surg. 1999; 67 866-869
- 12 Tsai F C, Chen H C, Chen S HT et al.. Free deepithelialized anterolateral thigh myocutaneous flaps for chronic intractable empyema with bronchopleural fistula. Ann Thorac Surg. 2002; 74 1038-1042
- 13 Banic A, Ris H B, Erni D et al.. Free latissimus dorsi flap for chest wall repair after complete resection of infected sternum. Ann Thorac Surg. 1995; 60 1028-1032
- 14 Ringelman P R, Vander Kolk C A, Cameron D et al.. Long term results of flap reconstruction in median sternotomy wound infections. Plast Reconstr Surg. 1994; 93 1208-1214
- 15 Brown R E, McCall T E, Neumeister M W. Use of free tissue transfer in the treatment of median sternotomy wound infections: retrospective review. J Reconstr Microsurg. 1999; 15 171-175
- 16 Kroll S S, Baldwin B J. Head and neck reconstruction with the rectus abdominis free flap. Clin Plast Surg. 1994; 21 97-108
- 17 Salgado C J, Mardini S, Chen H C et al.. Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indication for management using the “tissue-plug” technique. Plast Reconstr Surg. 2003; 112 957-963
Sukru YazarM.D.
Sancaktar Tekkesi Sok., Fen Apt. No: 37/29
34310 Kocamustafapasa, Istanbul, Turkey
Email: sukruyazar@hotmail.com