Intrathoracic transposition of a pectoralis major and pectoralis minor muscle flap for empyema in patients previously subjected to posterolateral thoracotomy

The latissimus dorsi muscle flap cannot be used to eliminate an empyema cav ity in patients who have previously undergone posterolateral thoracotomy, b ecause of the division of this muscle. Moreover, thoracoplasty alone cannot sufficiently eliminate an empyema cavity that includes the thoracic apex, where space remains between the clavicle and the first rib. Therefore, we c onstructed a flap from the pectoralis major (P.Ma) and pectoralis minor (P. Mi) muscles to eliminate empyema cavities in five patients who had undergon e lobectomy (n = 3) or pneumonectomy (n = 2) via posterolateral thoracotomy from 3 months to 40 years previously. All five patients had bronchopleural fistulae, and because of the previous upper lobectomy or pneumonectomy, th ey had large empyema cavities including the thoracic apex. Open-drainage th oracotomy was performed due to severe infection, and intrathoracic transpos ition of the P.Ma and P.Mi muscle flap with simultaneous thoracoplasty was carried out 7-124 weeks (mean 38 weeks) later. The P.Ma and P.Mi muscle fla p easily reached the apex space with sufficient obliteration of the empyema cavity. All of the patients remained free of empyema 12-85 months after th oracic closure. The P,Ma and P.Mi muscle flap is useful for eliminating emp yema cavities including the thoracic apex in patients who have previously u ndergone a posterolateral thoracotomy.