title: A new technique for muscle flap closure of the empyema space in complicated chronic bronchopleural fistula. Wedging the causative bronchus with a plug.
abstract: OBJECTIVE
  It is difficult to close the empyema space once it is opened, especially in cases complicated with a chronic bronchopleural fistula. A muscle flap closure is generally employed to prevent this situation. However, this operation occasionally fails because the space newly recurs around the fistula due to atrophic change occurring in these translocated muscles. The aim of the present new technique was to prevent inspiratory pressure from the inside of the bronchus by bronchial emboli, and help the adhesion between the fistula stump and the muscle flap, even if they have become atrophic and no longer have sufficient volume to fill the entire empyema space.
  
  
  METHODS
  We carried out fiberscopic embolism of causative bronchioles followed by muscle flap closure in 4 patients in whom open drainage had already been performed against parapneumonic empyema within the bronchial fistula. The bronchial fistula was plugged from the inside of the bronchus by silicon material, and stainless steel wire was used to connect this plug tightly to the muscle flaps, so that the fistula was sandwiched between them. In all cases, we succeeded in complete closure of the bronchial fistula and empyema space without using the omentum, and there has been no recurrence.
  
  
  CONCLUSIONS
  The presented new technique was beneficial for achieving muscle flap closure of the empyema space with a chronic bronchopleural fistula.
authors.affiliation: Department of Surgery, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Watanabe
authors.forename: Taiichirou
authors.initials: T
authors.lastname: Kanagawa
authors.forename: Koji
authors.initials: K
authors.lastname: Maeta
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohishi
authors.forename: Masahito
authors.initials: M
authors.lastname: Kodera
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D001980:Bronchi; D001983:Bronchial Fistula / Q000601:surgery*; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000379:methods*; D016724:Empyema, Pleural / Q000601:surgery*; D005402:Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles; D010995:Pleural Diseases / Q000601:surgery*; D013524:Surgical Flaps