Paraspinous muscle flap for the treatment of an empyema cavity

doi:10.1016/j.bjps.2011.11.009

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 65, Issue 6, June 2012, Pages 824-826

https://doi.org/10.1016/j.bjps.2011.11.009 Get rights and content

Summary

For the reconstruction of defects localised near the midline region of the back, there have been occasional reports of reconstruction using a paraspinous muscle flap; however, to the best of our knowledge, there have been no reports of empyema space reconstruction using a paraspinous muscle flap. A patient who developed empyema after a pulmonary lobectomy and in whom a paraspinous muscle flap was used to reconstruct a dead space in the medial region of the upper back created by fenestration is presented. The dead space was filled sufficiently, and the patient had a favourable course without complications. Although the rotation arc of the paraspinous muscle flap is limited, the flap’s blood flow is stable, and flap elevation is easy and less invasive.

The paraspinous muscle flap is useful for filling and closing a defect near the midline region of the back.

Section snippets

Case report

The patient was a 64-year-old man who underwent a total laryngectomy for laryngeal cancer 2 years earlier. One year after surgery, a lesion was seen in the right upper pulmonary lobe, and the patient was diagnosed as having metastatic lung cancer. Subsequently, a posterolateral incision was made, and the right upper pulmonary lobe was resected. Two weeks after surgery, a purulent discharge was seen from the thoracostomy tube. Based on the results of bacterial culture testing, the patient was

Discussion

Empyema occurs as a complication of severe pneumonia or after pulmonary lobectomy. It is difficult to treat by conservative medical therapy, and, in general, surgery is often selected. The basis of surgical therapy is: 1) infected tissue inside the thoracic cavity is eliminated and cleaned by washing or curettage; 2) if present, pulmonary and bronchial fistulae are closed; and 3) the empyema cavity is made smaller and closed. Tissues used for filling and closing empyema cavities are chosen

Conflict of interest

None declared.

References (10)

H. Watanabe et al.
Treatment of empyema by transposition of contralateral lower trapezius flap
Ann Thorac Surg
(1997)
Y. Okumura et al.
Surgical results for chronic empyema using omental pedicled flap: long-term follow-up study
Ann Thorac Surg
(2005)
M. Okuda et al.
Obliteration of empyema space by vascularized anterolateral thigh flaps
Ann ThoracSurg
(2009)
L. Jiang et al.
Free rectus abdominis musculocutaneous flap for chronic postoperative empyema
Ann Thorac Surg
(2008)
H. Seify et al.
Single-stage muscle flap reconstruction of the postpneumonectomy empyema space: the Emory experience
Plast Reconstr Surg
(2007)

There are more references available in the full text version of this article.

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Reducing drain use with paraspinal muscle flaps for spinal closures: A retrospective cohort study
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Paraspinal muscle (PSM) flaps can be mobilized with superficial undermining and lateral release from the thoracolumbar fascia and/or deep undermining and medial release from the transverse processes and ribs. The objective of the study was to compare the effect of the PSM flap technique on drain use, retention, and complication rates.
A retrospective chart review was performed for patients who underwent spinal coverage with PSM flaps at a single institution from April 2020 to June 2021. Patient demographics, preoperative comorbidities, surgical technique, drain usage, and postoperative complications were analyzed to compare the effects of different PSM flap surgical techniques on postoperative drain use and complications.
Sixty patients were included. Both superficial and deep releases were performed in half (47%) of the cases, while the remainder was split between superficial (25%) and deep (28%) releases. Drains were used less frequently for the deep release (35%) than the superficial (93%) or both releases (96%, p < 0.01). The deep release had shorter mean drain retention time (5.8 days) than the superficial (30.3 days) or both releases (24.8 days, p < 0.01). There were no significant differences between the techniques in terms of complications. For the deep release, the use of drains was not associated with a reduction in complications (odds ratio 0.91 [0.84 – 0.98], p = 0.97).
In a selected patient population, a “deep release only” PSM flap technique may allow for drainless spinal closure without an increased risk of seroma or other complications.
Chest wall reconstruction after the Clagett procedure and other types of open-window thoracostomy: a narrative review
2023, Journal of Thoracic Disease
Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities
2020, Microsurgery
Paraspinous muscle flap for the treatment of an empyema cavity: three case reports
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Case reportParaspinous muscle flap for the treatment of an empyema cavity

Summary

Section snippets

Case report

Discussion

Conflict of interest

Ann Thorac Surg

Ann Thorac Surg

Ann ThoracSurg

Ann Thorac Surg

Single-stage muscle flap reconstruction of the postpneumonectomy empyema space: the Emory experience

Plast Reconstr Surg

Case report
Paraspinous muscle flap for the treatment of an empyema cavity