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European Journal of Cardio-Thoracic Surgery, Vol 6, 635-638, Copyright © 1992 by European Association for Cardio-thoracic Surgery
F Smolle-Juttner, W Beuster, H Pinter, G Pierer, M Pongratz and G Friehs
Open-window thoracostomy (OWT) was performed in 21 cases of empyema. The
indications were postpneumonectomy empyema with (n = 6) or without (n = 1)
fistula, early recurrent empyema after decortication (n = 6), chronical
empyema in ill elderly patients with (n = 5) or without fistula (n = 2),
and total unilateral lung gangrene with a large fistula of the main
bronchus after radiotherapy and chemotherapy (n = 1). All cases presented
with severe sepsis, eight of them with acute septic shock, and six with
signs of multiorgan failure. Three to five ribs were resected, the muscles
and skin were sutured to the ribs confining the window located at the
lowest point of the empyema cavity, while the intercostal muscles of the
resected ribs were used to close fistulae. The cavity was packed with
dressings every day. In all cases, the sepsis subsided immediately after
OWT. With the exception of one patient with postpneumonectomy empyema, who
died of contralateral pneumonia on day 36, no surgery-related complications
were seen. Four further patients died of unrelated causes 2, 4, 5, and 7
months, respectively, after OWT. In one of them, the OWT had been closed.
Up to this time, obliteration and closure of the cavity has been carried
out in 7 cases by using thoracoplasty (n = 2) or predicted muscle flaps (n
= 5) either in the early course or after a delay of 11 to 23 months, with
fair functional and cosmetic results. In one further case, operative
closure has been planned. In seven of the eight remaining patients, four of
whom declined further operations, the cavities closed spontaneously,
despite their initial size after intervals of between 11 and 21 months.
ARTICLES
Open-window thoracostomy in pleural empyema
Klinik fur Thorax- und Hyperbare Chirurgie, Medizinische Hochschule, Graz, Austria.
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