Intrathoracic muscular transposition in chronic tuberculous empyema.
BACKGROUND
The effective management of chronic tuberculous empyema requires an evacuation of pus and a re-expansion of the lung or an obliteration of the empyema space such as closed thoracostomy, decortication, or open window thoracostomy (OWT) followed by intrathoracic muscular transposition (IMT). However, the most effective management of chronic tuberculous empyema is still debatable.


METHODS
From June 1999 to July 2010, 18 patients with chronic tuberculous empyema who underwent OWT and/or IMT were enrolled in this study. The causes of empyema, and methods and outcomes of treatment were retrospectively reviewed. The success rate of IMT was investigated to evaluate the efficacy.


RESULTS
Mean patient age was 54.3 ± 14.9 years and 16 patients were male. Depending on operative methods, three groups were divided: OWT only (n = 4); two-stage operation as OWT followed by IMT (n = 7); and one-stage operation as OWT with IMT simultaneously (n = 7). Of 14 patients who underwent IMT, 13 patients successfully recovered from empyema and bronchopleural fistula (BPF) (success rate, 92.86%), but one patient developed a secondary bacterial infection. There was no operative mortality.


CONCLUSIONS
This study suggests that IMT may be an effective option to control infection or BPF in chronic tuberculous empyema.
Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Hyo Yeong
HY
Ahn
Jeong Su
JS
Cho
Yeong Dae
YD
Kim
I
I
Hoseok
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D004654:Empyema, Tuberculous / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications