Surgical treatment of empyema after pulmonary resection using pedicle skeletal muscle plombage, thoracoplasty, and continuous cavity ablution procedures: a report on three cases

Abstract

We present three cases of postoperative empyema after pulmonary resection: case 1, acute empyema without fistula after lobectomy and chest wall resection; case 2, continuing empyema with fistula and total left residual lung abscess after upper divisionectomy; and case 3, chronic empyema with middle lobe bronchopleural fistula after lower lobectomy. Pedicle skeletal muscle plombage into the cavity, thoracoplasty, and continuous cavity ablution with 24-h instillation of minocycline and saline solution through drains were used for treatment. In case 2, a completion extrapleural left pneumonectomy was concurrently performed. In all three cases, the surgery was successful; however, case 2 developed a massive gastrointestinal hemorrhage, which led to blood aspiration pneumonitis, renal failure, and death. Muscle plombage effectively achieves the closure of empyema cavity and thoracoplasty complements this. When a residual space remains, cavity ablution is considered to be effective. However, concurrent completion lung parenchyma resection might be excessively aggressive.

Design variations in vertical muscle-sparing thoracotomy

“…VMST incision, which is made perpendicular to the PLT incision, offers several advantages such as avoiding the dissection of subcutaneous tissues above the LD muscle fascia. Preservation of the LD muscle is also important because its flaps can be used in a variety of surgical treatments for vital conditions (8,11). On the contrary, VMST may involve some disadvantages with regard to clinical and cosmetic perspectives because the chosen incision lines may not be parallel to Langer's cleavage lines.…”

A treatment protocol for chronic post‐pneumonectomy empyema associated with bronchopleural fistula: A single‐centre retrospective study

“…The second step in this protocol was closing BPF. As noted, BPF is presented in as many as 80% of patients with PPE and increases the mortality rate considerably, 9 firmly closing BPF is extremely important. In this study, techniques for BPF closure depend on fistula size 10 : (a) for small fistula with a diameter less than 1 mm, endoscopic treatment is very effective; although in some cases, multiple attempts might be taken; (b) for fistula with a diameter from 1 to 3 mm, since BPF is likely to reoccur after endoscopic treatment, patch is used.…”

Complex Biostimulation of Intrapleural Adhesiogenesis in Thoracal Surgery

“…Препараты, разработанные на основе аутологичных компонентов, все шире внедряются в косметологию и травматологию, однако в торакальной хирургии биотехнологии на основе PRP-технологий до настоящего времени не нашли применения, что и обусловливает актуальность данной работы. По-прежнему нерешенными проблемами остается стабилизация реберного каркаса при тяжелых сочетанных травмах и ликвидация остаточных полостей при хронических эмпиемах плевры, что требует поиска новых решений с применением биологической стимуляции адгезиогенеза в комплексном лечении данных нозологий [4][5][6][7]. ЦЕЛЬ РАБОТЫ -определение эффективности применения плазмы, обогащенной тромбоцитами, в комплексном лечении травмы грудной клетки и эмпиемы плевры.…”