Uso de los colgajos musculares en la enfermedad pleuropulmonar infecciosa complicada

Uso de los colgajos musculares en la enfermedad pleuropulmonar infecciosa complicada

Objective: to describe the results of applying muscle flaps in the treatment of complex infectious pleuropulmonar diseases. 
Materials y methods: From August 1, 2002 to July 31, 2003, 70 patients required surgical treatment for the management of complex infectious pleuropulmonar diseases at the Hospital Santa Clara, in Bogota D.C. Them ofthese patients have required intrathoracic rotation of muscle flaps and have been prospectively followed.
Results: this sample is composed of 8 man and 2 women, mean age 57 years (range 35 ~79). Two patients had previously been treated in other institution and arrived with an infected Eloesser Window. Nine of 10 patients had pus in their thoracic cavities at the moment of surgical intervention. The indication for muscle plat use were: broncopleural fistula closure in 4 patients, management of residual infected pleural space with multiple parenchyimatous fistulas in 2 patients, and management of esophageal fistula in 1 patient. Three patients had prophylactic covertures of the bronchial stump. Serratus was rotated in 5 patients, serratus and superior half of the dorsalis mayor in 3, serratus plus dorsalis, and 8” intercostals muscle in 1 patient each. A mean of 8 surgical procedures were required for infection control (range 1 to 22 procedures per patient). Mean hospital stay was 25 days (14 to 60), mechanical ventilatory support was required in all patients. At last follow-up, 2 patients are dead; one of them with an open thorax and with active infection. _Six patients (60%) have a satisfactory evolution without evidence of fistula or infection. 
Conclusion: muscle flaps are an effective method for the management of complex infectious pleuropulmonar diseases; and are recommended when mayor pulmonary resection is required for the treatment of empyema.