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thoracostomy for
thoracic empyema: Open window
thoracostomy is a simple, certain and final drainage procedure for
thoracic empyema. It is most useful to drain purulent effusion from
empyema space, especially for cases with broncho-pleural
fistulas, and to clean up purulent necrotic debris on surface of
empyema sac. For changing of packing gauzes in
empyema space through a window once or twice every day after this procedure,
thoracostomy will have to be made on the suitable position to
empyema space. Usually skin incision will be layed along the costal bone just at the most expanded position of
empyema. Following muscle splitting to thoracic wall, a costal bone just under the incision will be removed
as 8-10 cm as long, and opened the
empyema space through a costal bed. After the extension of
empyema space will be preliminarily examined through a primary window by a finger or a long
forceps, it will be decided costal bones must be removed how many (usually 2 or 3 totally) and how long (6-8 cm) to make a window up to 5 cm in diameter. Thickened
empyema wall will be cut out just according to a window size, and finally skin edge and
empyema wall will be sutured roughly along circular edge. Muscle flap transposition for
empyema space: Pediclued muscle flap transposition is one of space-reducing operations for (chronic)
empyema Usually this will be co-performed with other several procedures as
curettages on
empyema surface, closure of bronchopleural
fistula and
thoracoplasty. This is radically curable for primarily non fistulous
empyema or secondarily
empyema after open window
thoracostomy done for
fistula. Furthermore this is less invasive than other radical operations as like pleuro-
pneumonectomy, decortication or air-plombage for
empyema. There are 2 important points to do this technique. One is a volume of muscle flap and another is good blood flow in flap. The former suitable muscle volume is need to impact
empyema space or to close
fistula, and the latter over-elongation and bending of pedicles should be avoided. Actually, after removing several costal bones on the
empyema space,
empyema wall will be incised for about 2/3 of total
empyema length along costal beds. Then muscle flap will be introduced into cleaned up space and sutured on
empyema surface at several points. It is better to lay small vacuum drain tubes along flap within
empyema space.