Thoracomyoplasty for Chronic Empyema and Osteoradionecrosis of the Chest Wall

Abstract

Herein, we report a case in which thoracomyoplasty was performed to manage chronic postlobectomy empyema (PLE). A 54-year-old male patient with a surgical history of right upper lobectomy and thymectomy 35 years previously who had undergone adjuvant radiotherapy presented with purulent discharge on the anterior chest wall. The patient was diagnosed with chronic PLE with ascending infection and concurrent osteonecrosis of the parasternum. Proper drainage was performed for local infection control and the dead spaces were successfully closed with muscle flaps. There have been no complications to date.

Keywords: Myocutaneous flap; Osteoradionecrosis; Pleural empyema; Thoracoplasty.

Fig. 1

(A) Preoperative computed tomography showing chronic empyema with a right apical calcified sac with an air-fluid level. (B) An ulcerative skin lesion in the anterior chest wall that was suspicious for a fistula.

Fig. 2

(A) Anterior chest wall defect after removing the infected soft tissue and costosternal junction. (B, C) Vertical rectus abdominis myocutaneous flap harvesting and transposition.

Fig. 3

Postoperative follow-up at the outpatient clinic.