title: Pedicle muscle flap transposition for chronic empyema with persistent bronchopleural fistula: experience of a single clinical center in China.
abstract: OBJECTIVE
  The management of chronic empyema with persistent bronchopleural fistula (BPF) is a major challenge for surgeons. We report our experience of performing pedicle muscle flap transposition for chronic empyema with BPF in a clinical center in China.
  
  
  METHODS
  The subjects of this study were 13 patients with postoperative chronic empyema and persistent BPF. The surgical procedure performed was chosen according to the degree of infection in the empyema cavity. Patients with mild contamination underwent one-stage cavity decortication with flap transposition, whereas patients with severe infection underwent two-stage surgery including open-window thoracostomy and pedicle muscle flap transposition.
  
  
  RESULTS
  Five patients underwent one-stage surgery, followed by an uneventful postoperative course in all except one. The other eight patients underwent two-stage surgery. The fistulas closed spontaneously during the course of dressings and six of these eight patients underwent second-stage surgery uneventfully. A bronchopleurocutaneous sinus developed in the wounds of the other two patients.
  
  
  CONCLUSIONS
  Pedicle muscle flap transposition is a viable option for chronic empyema with BPF; however, surgical procedures should be selected according to the degree of contamination. For two-stage surgery, obliteration of the cavity should be considered, preferably after closure of the fistula.
authors.affiliation: Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Chunlai
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Zihao
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China. gedi@hotmail.com.
authors.forename: Di
authors.initials: D
authors.lastname: Ge
authors.affiliation: Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China. qi.fazhi@zs-hospital.sh.cn.
authors.forename: Fazhi
authors.initials: F
authors.lastname: Qi
authors.affiliation: Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Gu
authors.affiliation: Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Fenglin Road 180, Shanghai, 200032, China.
authors.forename: Fengkai
authors.initials: F
authors.lastname: Xu
mesh_terms: D000328:Adult; D001983:Bronchial Fistula / Q000601:surgery*; D002681:China; D002908:Chronic Disease; D004653:Empyema / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D013524:Surgical Flaps; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bronchopleural fistula; Chronic empyema; Pedicle muscle flaps