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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 958-966, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PC Pairolero, PG Arnold, VF Trastek, NB Meland and PP Kay
Forty-five patients (36 male and nine female) were treated for
postpneumonectomy empyema. All were initially managed with the first stage
of the Clagett procedure (open pleural drainage). In 28 patients with
associated bronchopleural fistula the fistula was closed and reinforced
with muscle transposition at the time of open drainage. Seven patients had
multiple flaps. The serratus anterior muscle was transposed in 28 patients,
latissimus dorsi in 11, pectoralis major in four, pectoralis minor in one,
and rectus abdominis in one patient. After the fistula was closed and the
pleural cavity was clean, the second stage of the Clagett procedure
(obliteration of the pleural cavity with antibiotic solution and closure of
the open pleural window) was done. The number of operative procedures
ranged from 1 to 19 (median 5.0). Length of hospitalization ranged from 4
to 137 days (median 34.0 days). There were six operative deaths (mortality
rate 13.3%), none in the patients who had both stages of the Clagett
procedure. Follow-up of the 39 operative survivors ranged from 2.1 to 90.2
months (median 21.8 months). Eighty-four percent of patients in whom the
Clagett procedure was completed (26/31) had a healed chest wall with no
evidence of recurrent infection. The bronchopleural fistula remained closed
in 85.7% of patients (24/28). There were 19 late deaths, none related to
postpneumonectomy empyema. We conclude that the Clagett procedure remains
safe and effective in the management of postpneumonectomy empyema in the
absence of bronchopleural fistula and that intrathoracic muscle
transposition to reinforce the bronchial stump is an effective procedure in
the control of postpneumonectomy- associated bronchopleural fistula.
ARTICLES
Postpneumonectomy empyema. The role of intrathoracic muscle transposition
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minn.
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