title: The role of intrathoracic free flaps for chronic empyema.
abstract: BACKGROUND
  The management of chronic empyema associated with a bronchopleural fistula can be a particularly challenging problem. Successful eradication may not occur without interposition of healthy vascularized tissue. Pedicled muscle flaps for coverage on the thorax have been well described. However, secondary to trauma or previous surgical procedures, a pedicle flap may not be sufficiently sized or available. Free tissue transfer is an attractive option to provide the appropriate vascularized tissue.
  
  
  METHODS
  Six patients with chronic empyema-bronchopleural fistulae were reconstructed with 4 rectus abdominis myocutaneous and 2 gracilis muscle flaps. The choice of recipient vessels was dictated by existing local anatomy but included intercostal, thoracodorsal, thoracoacromial, azygous, and circumflex humeral vessels. One flap required interposition saphenous vein grafts for both artery and vein.
  
  
  RESULTS
  Patient follow-up ranged from 2 to 14 years. There were no episodes of flap loss or postoperative mortality. Empyema resolution without recurrent bronchopleural fistula was achieved in all patients.
  
  
  CONCLUSIONS
  Free tissue transfer is an excellent option for vascularized tissue interposition in patients who are not candidates for pedicled muscle transfer. Multiple potential recipient vessels provide tremendous versatility, arguing for early consideration of free tissue transfer.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia 30308, USA. mark.walsh@emory.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Walsh
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Bruno
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Detlev
authors.initials: D
authors.lastname: Erdmann
authors.forename: Walter G
authors.initials: WG
authors.lastname: Wolfe
authors.forename: Eric M
authors.initials: EM
authors.lastname: Toloza
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000601:surgery*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D012189:Retrospective Studies; D035423:Thoracic Cavity; D013997:Time Factors; D016896:Treatment Outcome