Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection

Objective: Successful treatment of postoperative empyema remains a challeng e for thoracic surgeons. We report herein our 12-year experience in the man agement of this condition by means of open window thoracostomy. Methods: Open window thoracostomy was used in the treatment of 46 patients with empyema complicating pulmonary resection. A bronchopleural fistula was associated in 39 of 46 cases, Previous operations included pneumonectomy ( n = 30), bilobectomy (n = 5), lobectomy (n = 9), and wedge resection (n = 2 ) performed for benign (n = 10) or malignant (n = 36) disease. In 10 patien ts open window thoracostomy was definitive because of patient death (n = 2) , concomitant major illness (n = 2), tumor recurrence (n = 4), spontaneous closure (n = 1), or patient choice (n = 1), In 36 cases intrathoracic flap transposition was eventually performed, Muscular (n = 29), omental (n = 5), or combined muscular and omental (n = 2) flaps were used to obliterate the thoracostomy cavity and to close a possibly associated bronchopleural fist ula, In 9 patients with postpneumonectomy cavities too wide to be filled by the available flaps, a limited thoracoplasty represented an intermediate s tep. Results: Among patients treated with definitive open window thoracostomy, l ocal control of the infection was achieved in all the survivors (8/8), Afte r open window thoracostomy and subsequent flap transposition, success (defi nitive closure of the thoracostomy and, if present, of the bronchopleural f istula) was achieved in 27 (75.0%) of 36 patients. Four initial failures co uld be salvaged by means of reoperation (initial reopening of thoracostomy and subsequent muscular or omental transposition). Conclusion: Open window thoracostomy followed by intrathoracic muscle or om ental transposition represents a valid therapeutic option in patients with empyema complicating pulmonary resections.