Nomori H, Horio H, Kobayashi R, Hasegawa T
Department of Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Thorac Cardiovasc Surg. 1995 Jun;43(3):171-5. doi: 10.1055/s-2007-1013793.
Intrathoracic transposition of the musculocutaneous (MC) flaps of the latissimus dorsi and rectus abdominis was performed after open-drainage thoracotomy in 6 patients with empyema. The MC flaps were designed in such a way that the muscle-bearing skin paddle was extended well beyond the distal muscle borders. The MC flaps thus provided substantially larger pieces compared to muscle flaps. With the exception of one patient with persistent bronchopleural fistula whose empyema recurred due to the reopening of the fistula, the thoracic closure was successful in all patients. Postoperative magnetic resonance imaging revealed a well-preserved volume of subcutaneous tissue in the flaps, while the muscle portions of the flaps had atrophied. In conclusion, compared to muscle flaps, MC flaps have the advantages that (1) larger empyema cavities can be obliterated, and (2) the deformity of the thoracic wall can be minimized because of the small range of resected rib segments and well-preserved volume of subcutaneous tissue in the flap long after the transposition. The use of MC flaps is thus indicated for the empyema cavity remaining when a cavity is cleaned up of granulatous tissue with eradication of bronchopleural fistula.
对6例脓胸患者在开胸引流术后进行了背阔肌和腹直肌肌皮瓣的胸腔内转位。肌皮瓣的设计方式是使带肌肉的皮瓣延伸至远超过肌肉远端边界。因此，与肌瓣相比，肌皮瓣能提供大得多的组织块。除1例因支气管胸膜瘘重新开放导致脓胸复发的持续性支气管胸膜瘘患者外，所有患者的胸腔闭合均成功。术后磁共振成像显示皮瓣内皮下组织体积保存良好，而皮瓣的肌肉部分出现萎缩。总之，与肌瓣相比，肌皮瓣具有以下优点：（1）能消除更大的脓腔；（2）由于转位后很长时间皮瓣内切除的肋骨段范围小且皮下组织体积保存良好，胸壁畸形可减至最小。因此，当清除脓腔中的肉芽组织并根除支气管胸膜瘘后仍有脓腔残留时，建议使用肌皮瓣。
