Tsuji H, Ozeki M, Yokoyama K, Tachibana S, Harunari H, Kawakami M, Orino T, Morimoto T, Takeuchi A, Tanaka Y
Rinsho Kyobu Geka. 1989 Jun;9(3):297-300.
A 59-year-old man, who had had right middle and lower lobectomy for pulmonary tuberculosis, admitted for the treatment of empyema with fistula. Closure of empyema space with free rectus abdominis myocutaneous flap was performed following open window thoracotomy and thoracoplasty. As he previously underwent two major operation, lobectomy by posterolateral approach and gastrectomy for gastric ulcer, free rectus abdominis flap was chosen instead of omental flap or latissimus dorsi myocutaneous flap. Postoperative CT film showed that this flap was filled up in all interstices of the empyema cavity. The pedicle vessels to this flap are large enough to provide long stalks, so microsurgical anastomosis can be accomplished safely. The use of free rectus abdominis myocutaneous flap is one of a useful maneuver for chronic empyema with fistula.
一名59岁男性，曾因肺结核接受右肺中叶及下叶切除术，现因脓胸伴瘘管入院治疗。在开胸开窗术和胸廓成形术后，采用游离腹直肌肌皮瓣封闭脓腔。由于他之前接受过两次大手术，即后外侧入路肺叶切除术和胃溃疡胃切除术，因此选择游离腹直肌瓣而非网膜瓣或背阔肌肌皮瓣。术后CT片显示该皮瓣填充了脓腔的所有间隙。该皮瓣的蒂血管足够粗大，能够提供较长的蒂，因此可以安全地完成显微外科吻合。游离腹直肌肌皮瓣的应用是治疗慢性脓胸伴瘘管的有效方法之一。
