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. 2016 Jul;8(7):1697-703.
doi: 10.21037/jtd.2016.05.91.

Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

Shuichi Shinohara  1 , Yasuhiro Chikaishi  1 , Taiji Kuwata  1 , Masaru Takenaka  1 , Soichi Oka  1 , Ayako Hirai  1 , Naoko Imanishi  1 , Koji Kuroda  1 , Fumihiro Tanaka  1
Affiliations

Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

Shuichi Shinohara et al. J Thorac Dis. 2016 Jul.

Abstract

Background: Open window thoracotomy (OWT) as well as its closure are challenging. Transposition of omental pedicle and muscle flaps is often performed for OWT closure; however, the better technique among the two is unknown. The purpose of this series was to evaluate the outcomes of using both omental pedicle and muscle flaps for the aforementioned closure.

Methods: This was an observational retrospective cohort study on 27 consecutive patients who underwent OWT closure at a single institution between January 2005 and December 2014. The operation was performed using either omental pedicle or muscle flap with thoracoplasty. We compared both techniques in terms of the patient background [sex, age, body mass index (BMI) and C-reactive protein (CRP) before OWT and serum albumin levels before OWT closure], presence of methicillin-resistant Staphylococcus aureus (MRSA) infection, rate of bronchopleural fistula (BPF), duration of OWT, recurrence of local infection, morbidity, duration of indwelling drainage after operation, success, mortality and postoperative hospital stay.

Results: There were 9 (33.3%) omental pedicle flap procedures and 18 (66.7%) muscle flap procedures. The rate of local recurrence after closure of OWT was significantly higher with muscle flap than with omental pedicle flap (0% vs. 50.0%, P=0.012). The median duration of postoperative hospital stay was significantly shorter with omental pedicle flap than that with muscle flap (16.0 vs. 41.5 days, P=0.037). Mortality was observed in 2 patients (11.2%) in the muscle flap group and no patient in the omental pedicle flap group. Success rate was similar between the two groups (100% for omental pedicle flap vs. 83.3% for muscle flap).

Conclusions: Omental pedicle flap was superior to muscle flap in terms of reducing local recurrence and shortening postoperative hospital stay. However, mortality, morbidity and success rates were not affected by the choice of flap.

Keywords: Open window thoracotomy (OWT); closure; empyema; muscle; omentum.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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