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Review
. 2023 Dec 30;15(12):7063-7076.
doi: 10.21037/jtd-23-684. Epub 2023 Dec 4.

Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review

Alieske Kleeven  1 , Seth Rianna P van der Hel  1 , Yasmine M J Jonis  1 , Jairo J A Profar  1 , Jean H T Daemen  2 , Erik R de Loos  2 , René R W J van der Hulst  1 , Shan Shan Qiu  1
Affiliations
Review

Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review

Alieske Kleeven et al. J Thorac Dis. .

Abstract

Background and objective: The Clagett procedure is one of the last treatment options for chronic stage pleural empyema. It involves the formation of an open-window in the thoracic wall to allow for continuous drainage and irrigation of the pleural cavity. Once the empyema has been resolved, reconstruction of the chest wall is sometimes challenging. This review aims to identify and summarize the options for reconstructing soft tissue defects of the chest wall following the Clagett procedure and other types of open-window thoracostomy.

Methods: A narrative review was performed of the literature on PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar, including all relevant studies published until January 2023.

Key content and findings: This review contains an overview of the reconstruction methods and the outcomes of the included studies on reconstructive options after the Clagett procedure and other types of open-window thoracostomy. A subdivision was made based on reconstruction type: pedicled flaps, free flaps, and the use of a vacuum-assisted closure (VAC) device. The advantages of pedicled flaps are reliable vascularization, better tissue match, reduced scarring, and shorter operation time compared to free flaps. However, when pedicled flaps are not available due to damage during previous surgeries or offer insufficient volume to obliterate the cavity, free flaps might be a solution.

Conclusions: In cases where an open-window thoracostomy necessitates chest wall reconstruction, a pedicled flap is the preferred choice, followed by free flaps. Additionally, vacuum-assisted negative pressure wound therapy (VANPWT) techniques have shown potentially promising results (as an adjunct to surgical treatment).

Keywords: Clagett; Empyema; open-window thoracostomy; reconstruction.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-684/coif). The series “Chest Wall Resections and Reconstructions” was commissioned by the editorial office without any funding or sponsorship. E.R.d.L. and J.H.T.D. served as the unpaid Guest Editors of the series. E.R.d.L. gets consulting fees from Johnson & Johnson for training in uniportal VATS lobectomy. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart: systematic approach for choosing a method for reconstructing the thoracic wall after open-window thoracostomy. BPF, bronchopleural fistula; VANPWT, vacuum-assisted negative pressure wound therapy.
See this image and copyright information in PMC

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