title: Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema.
abstract: BACKGROUND
  Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome.
  
  
  METHODS
  We retrospectively analyzed 17 patients (11 men, 6 women) with chronic postlobectomy empyema who were treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior-rhomboid myoplasty, which also served to close a bronchopleural fistula, if present. The first rib was resected in 11 of 17 patients.
  
  
  RESULTS
  The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration, and definitive closure of bronchopleural fistula, irrespective of the type of infection, the presence of a bronchopleural fistula, or whether a first rib resection was performed. Postlobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV(1) of 63.0%±8.5% and 51.5%±4.2% (p=0.01) and a mean predicted DLCO of 59.8%±11.6% and 54.5%±12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy.
  
  
  CONCLUSIONS
  Tailored thoracomyoplasty represents a valid option for patients with chronic postlobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control were equally obtained with and without first rib resection.
authors.affiliation: Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Ian
authors.initials: I
authors.lastname: Fournier
authors.forename: Thorsten
authors.initials: T
authors.lastname: Krueger
authors.forename: Yabo
authors.initials: Y
authors.lastname: Wang
authors.forename: Antoine
authors.initials: A
authors.lastname: Meyer
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013905:Thoracoplasty / Q000379:methods*; D016896:Treatment Outcome