Mendes Margarida, Almeida Alexandre, Costa Rita, Paiva Anita, Jarnalo Mariana, Gandra Gonçalo, Machado Pedro, Horta Ricardo, Coelho Rúben
Department of Plastic, Reconstructive and Aesthetic Surgery, and Burn Unit, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Eplasty. 2023 Dec 8;23:e76. eCollection 2023.
Tuberculous empyema is rare. Its treatment requires oral antituberculous drugs, empyema drainage, and in severe cases, decortication and pneumectomy. In the presence of tuberculosis, lung resection has a high risk of postoperative bronchopleural fistula (BPF) and empyema. Treatment includes drainage, fistula occlusion, dead space obliteration, and infection control. Muscle flap transfer allows BPF occlusion and dead space obliteration.
This report presents a case of a 63-year-old man with tuberculosis and postoperative BPF with empyema after pleural decortication and left lower lobe resection. The empyema was drained, and antituberculous drugs were started. The BPF was occluded with a latissimus dorsi and serratus anterior chimeric muscle flap, and the remaining thoracic dead space and chest wall defect were reconstructed with a pedicled pectoralis major myocutaneous flap.
Healing occurred uneventfully, and the patient was discharged from the hospital after 2 weeks.
This type of thoracic defect is rare nowadays, especially in the setting of tuberculous infections. Although workhorse flaps like latissimus dorsi or pectoralis major flaps have been progressively surpassed by more elegant solutions like fasciocutaneous pedicled flaps and free flaps, they must still be considerations in the decision-making process of a reconstructive surgeon, and flap choice must be made on a case-by-case basis.
结核性脓胸较为罕见。其治疗需要口服抗结核药物、脓胸引流，严重时还需要进行胸膜剥脱术和肺切除术。在存在结核病的情况下，肺切除术后发生支气管胸膜瘘（BPF）和脓胸的风险较高。治疗包括引流、瘘管封堵、消灭死腔和控制感染。肌瓣转移可实现BPF封堵和死腔消灭。
本报告介绍了一例63岁男性患者，在胸膜剥脱术和左下叶切除术后发生结核病并伴有BPF和脓胸。进行了脓胸引流并开始使用抗结核药物。采用背阔肌和前锯肌嵌合肌瓣封堵BPF，并用带蒂胸大肌肌皮瓣重建剩余的胸腔死腔和胸壁缺损。
愈合过程顺利，患者在2周后出院。
如今这种类型的胸部缺损较为罕见，尤其是在结核感染的情况下。尽管像背阔肌或胸大肌皮瓣这样的常用皮瓣已逐渐被像带蒂筋膜皮瓣和游离皮瓣这样更精巧的解决方案所超越，但在重建外科医生的决策过程中它们仍需被考虑，且必须根据具体病例选择皮瓣。
