OMENTOPEXY AND MUSCLE TRANSPOSITION - 2 ALTERNATIVE METHODS IN THE TREATMENT OF PLEURAL EMPYEMA AND MEDIASTINITIS

From March 1987 to March 1993, 64 patients with chronic empyema and me diastinitis were treated with omentum and thoracic muscle transpositio n. There were 36 male and 28 female patients, age range 29 to 76 years . 31 patients suffered from chronic empyema and bronchopleural fistula after lung surgery, 18 patients had chronic empyema after pulmonary i nflammatory disease, and 15 patients developed a mediastinitis with or without pleural empyema after cardiac surgery or irradiation of the c hest wall. The pedicled omentum was used in 33, the thoracic muscles l atissimus dorsi, pectoralis major, serratus anterior, and trapezius ei ther alone or combined in 31 cases. There were no perioperative deaths . Bronchopleural fistulas and infected spaces were successfully closed in 61 patients (95.3%). Postoperative CT scan, angiography, bronchosc opy, and lung function tests demonstrate the efficacy of both surgical methods. Omentum pedicle and thoracic muscle flaps supply excellent v ascularised tissue to fill infected pleural space and mediastinum, par ticularly in patients with limited cardiopulmonary function.