Abstract:

Objective To sum up experience in the treatment of chronic tuberculous refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017, 12 patients with chronic tuberculous refractory empyema were treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital. After dressing up the wound, transplantation and filling of rectus abdominis myocutaneous flap or latissimus dorsi myocutaneous flap was performed in patients with history of ipsilateral surgical operation and the ipsilateral latissimus dorsi myocutaneous flap or pectoralis major myocutaneous flap was transfered and filled in patients without the history of ipsilateral surgical operation. The patients were treated with triplex regimen including isoniazid, rifampicin and pyrazinamide for more than 3months before operation, and continue this regimen for 12months after operation. The regimen was adjusted by the result of drug susceptibility test. All patients were males with median age 52.5 (26.0-65.0) years old. Seven cases had previous pneumonectomy including pneumonectomy in 2 cases due to pulmonary tuberculosis and bronchopleural fistula (BPF), drainage and other conservative treatment not be cured, then chest wall fenestration, and long-term dressing change in 5 cases. Chronic tuberculous refractory empyema conservative treatment (drainage, etc.) could not be cured and the lung could not be reopened for opening window to change medicine in the other 5 cases without previous operation history.Results No death cases and no respiratory complications occurred in these patients. Thoracic drainage tube was successfully removed within 5days and discharged from hospital for 3 to 6 weeks after operation. The median follow-up time was 9months. There was no recurrence of empyema and myocutaneous flap necrosis in 11 patients. Local recurrence of empyema in 1 case (removal of old occluder, application of a new type of Sheffler occluder during non-edema period, preparation for secondary musculocutaneous flap filling).Conclusion The application of auto-logous myocutaneous flap implantation combined with special materials (memory alloy scaffold), microsurgical techniques, chemotherapy and traditional operation of tuberculous empyema, in the treatment of chronic tuberculous refractory empyema has a good clinical effect.

Key words: Empyema, tuberculous, Chronic disease, Transplantation, autologous, Surgical flaps, Open-window thoracostomy