Seify Hisham, Mansour Kamal, Miller Joseph, Douglas Trent, Burke Renee, Losken Albert, Culbertson John, Jones Glyn, Nahai Foad, Hester T Roderick
Atlanta, Ga. From the Joseph Whitehead Department of Surgery, Divisions of Plastic Surgery and Thoracic Surgery, Emory University.
Plast Reconstr Surg. 2007 Dec;120(7):1886-1891. doi: 10.1097/01.prs.0000256051.99115.fb.
Postsurgical chronic empyema continues to present a complicated treatment scenario for thoracic and reconstructive surgeons. Muscle flaps are an important option in the management of complex thoracic wounds. This study was designed to report the Emory experience with muscle flaps for the management of complex postsurgical empyema. The authors also present their treatment algorithm for managing empyema thoracis.
The authors retrospectively reviewed the charts of 55 patients requiring different treatment modalities, including muscle flap transposition. Patients were divided into four groups according to the initial thoracic procedure: group A, no surgical resection; group B, postpneumonectomy; group C, postlobectomy; and group D, prophylactic postpneumonectomy or postlobectomy. The study included 42 men (76.4 percent) and 13 women with a mean age of 62 years (range, 39 to 77 years).
Fifty-one muscle flap procedures were performed in 42 patients (serratus anterior flaps, 16 patients and 23 flaps; latissimus dorsi flaps, 16 patients and 18 flaps; pectoralis major muscle flaps, intercostal muscle flaps, and rectus abdominis flaps, three patients each: omental flap, one patient). The mean number of ribs resected before flap intervention, usually during the open window thoracostomy, was three. The average time from initial thoracic operation to flap intervention was 4 months. Average time from flap intervention to discharge was 12.5 days. Average hospital stay was 26.6 days. The 51 muscle flaps represented an average of 1.2 procedures per patient.
Because of the excellent blood supply of extrathoracic muscle flaps and their ability to reach any place in the pleural cavity, they represent an ideal tissue with which to fill the contaminated pleural space.
术后慢性脓胸仍然给胸外科和重建外科医生带来复杂的治疗情况。肌皮瓣是处理复杂胸部伤口的重要选择。本研究旨在报告埃默里大学使用肌皮瓣治疗复杂术后脓胸的经验。作者还介绍了他们治疗脓胸的算法。
作者回顾性分析了55例需要不同治疗方式（包括肌皮瓣转移）患者的病历。根据最初的胸部手术将患者分为四组：A组，未行手术切除；B组，肺叶切除术后；C组，肺段切除术后；D组，预防性肺叶切除或肺段切除术后。该研究包括42名男性（76.4%）和13名女性，平均年龄62岁（范围39至77岁）。
42例患者共进行了51次肌皮瓣手术（前锯肌皮瓣，16例患者，23块皮瓣；背阔肌皮瓣，16例患者，18块皮瓣；胸大肌皮瓣、肋间肌皮瓣和腹直肌皮瓣，各3例患者；大网膜皮瓣，1例患者）。在皮瓣干预前（通常在胸廓开窗引流术期间）切除的肋骨平均数量为3根。从最初的胸部手术到皮瓣干预的平均时间为4个月。从皮瓣干预到出院的平均时间为12.５天。平均住院时间为26.6天。51块肌皮瓣平均每位患者进行了1.2次手术。
由于胸外肌皮瓣血供良好且能够到达胸膜腔的任何部位，它们是填充污染胸膜腔的理想组织。
