OPEN-WINDOW THORACOSTOMY AND THORACOMYOPLASTY TO MANAGE CHRONIC PLEURAL EMPYEMA

Background. The purpose of this study is to report our 15-year experie nce treating chronic empyemas after pulmonary resection and tuberculos is, Methods. Open-window thoracostomy and thoracomyoplasty were used t o treat 40 patients with chronic pleural empyema characterized by resi dual empyematic cavity, bronchopleural fistula, and persistent pleural infections that were secondary to tuberculosis (n = 22) or pulmonary resection (n = 18). Between 2 and 7 months after thoracostomy, thoraco myoplasty was performed to eliminate a persistent pleural cavity. In 2 patients with postpulmonary resection empyema and a large bronchopleu ral fistula, intrathoraic transposition of the latissimus dorsi flap a nd open-window thoracostomy were performed simultaneously to close the fistula. Results. The pleural space was eliminated per primam intenti onem in 21 of 22 patients with tuberculosis and in 14 of 18 with a pos tpulmonary resection empyema. Another myoplasty was performed in an ad ditional 3 patients to eliminate the pleural space. During open window thoracostomy, the latissimus dorsi muscle was preserved with minimal injury to the anterior serratus muscle. One patient died postoperative ly. Conclusions. Successful treatment of chronic pleural empyema requi res adequate timing of surgical procedures. Our two-procedure techniqu e is relatively simple and safe. (C) 1998 by The Society of Thoracic S urgeons.