title: Open window thoracostomy and thoracoplasty to manage 90 postpneumonectomy empyemas.
abstract: BACKGROUND
  Postpneumonectomy empyema (PPE) is a serious complication. The treatment options are similar to the management of any abscess, with drainage, ideally open, often of critical importance. After infection control, many techniques for space obliteration have been described. This study summarizes a 10-year experience in the management of PPE in our center.
  
  
  METHODS
  From 2000 to 2010, 90 patients (83 men) with PPE were treated. Median follow-up was 5.3 years. Once the diagnosis of empyema was confirmed, chest drainage was performed through open window thoracostomy (OWT), with ensuing extramusculoperiosteal thoracoplasties if healthy tissue was present.
  
  
  RESULTS
  Pneumonectomy was performed in 72 patients with lung cancer. Mortality after PPE was 2.2%. OWT achieved infection control in 89 patients. Seven OWT spontaneously healed, and 24 were never closed. The remaining 59 patients with OWT underwent thoracoplasty. Mortality after thoracoplasty was 5%. Empyema recurred in 3 patients. Overall success rate of PPE control after pleural obliteration was 91.5%.
  
  
  CONCLUSIONS
  Thoracoplasty is a reliable filling procedure. It has a significantly higher success rate and a lower mortality rate than the other techniques. We believe that this procedure has a part to play in the future management of PPE.
authors.affiliation: Department of Thoracic Surgery, "Albert Calmette" Hospital, Lille, France. ilirhysi@gmail.com
authors.forename: Ilir
authors.initials: I
authors.lastname: Hysi
authors.forename: Natacha
authors.initials: N
authors.lastname: Rousse
authors.forename: Antoine
authors.initials: A
authors.lastname: Claret
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Bellier
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Frédéric
authors.initials: F
authors.lastname: Wallet
authors.forename: Rias
authors.initials: R
authors.lastname: Akkad
authors.forename: Henri
authors.initials: H
authors.lastname: Porte
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016724:Empyema, Pleural / Q000209:etiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013905:Thoracoplasty; D013907:Thoracostomy / Q000379:methods*