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.

It should be emphasized that most cases of chest empyema can be successfully treated with conventional thoracic surgery procedures. For chronic empyema with a bronchopleural fistula complicated by previous division of major local muscles following repeated thoracotomies, free muscle flaps are employed. Five such cases treated with this method resulted in successful closure of the airway fistula, as well as complete obliteration of the empyema cavity in a single operation. This method is very effective in eradicating infection and achieves prompt wound healing, decreased morbidity, and gradual improvement of pulmonary function after surgery. Analysis of roentgen ray and computed tomographic scans before and after surgery shows lung expansion when the transferred muscles atrophy. The results are satisfactory. The method described here is not the only solution to this problem, but it is a new approach that has advantages not seen in conventional methods. It is indicated only in patients who have been operated on many times and who have no remaining available local muscles.