Chest Wall Reconstruction for Chronic Intrathoracic Wounds Using Various Flaps

Journal of the Korean Society for Surgery of the Hand 2000;9(1):68-74.
Published online May 31, 2000.

Joon Pio Hong, M.D., Pil-Dong Cho, M.D., Sug Won Kim, M.D., Yoon-Kyu Chung, M.D., Eun-Gi Kim, M.D.*

Abstract

  The treatment of chronic chest wounds should be focused on eradicating the infection and obliterating the dead space thus providing improved pulmonary function. Chronic chest wounds, although the incidence has decreased over the years, is still associated with high morbidity and prolong hospitalization. In cases where the disease is advanced and conventional measures fail, aggressive approaches achieve adequate resolution or significant improvement. This paper reports four cases of chronic chest wound including bronchopleural fistula and osteomyelitis managed by debridement followed by muscle coverage using latissimus dorsi, rectus abdominis, and omental flap. The intrathoracic reconstruction entails thorough debridement of empyema cavities, bronchpleural fistulas and infection focus. The infection must be completely eradicated prior to or at the time of flap transposition. The flaps used for obliteration of dead spaces provided adequate bulk, abundant blood supply, and minimal donor morbidity. The results were satisfactory with improved respiratory function without complications.

Key Words: Intrathoracic reconstruction, Bronchopleural fistula, Latissimus dorsi flap, Rectus abdominis flap, Omental flap