Content area
Full text
Background
In cases of difficult empyema after open-window thoracotomy(OWT), thoracic wall reconstruction procedures such as thoracomyoplasty or transposition using omental and muscle flaps have been performed to achieve chest closure. However, these surgeries are often invasive and are challenging to perform in cases with various comorbidities. Currently, there are few reports on simple chest closure procedures after OWT. In this report, we present two cases of empyema after OWT in which we achieved chest closure with minimally invasive simple wound closure.
Case presentation
Case 1
An 81-year-old man was readmitted after video-assisted thoracoscopic right lower lobectomy for right lower lobe lung cancer because a bronchial stump fistula had developed. OWT was performed, and the bronchial stump was closed with a 4–0 monofilament suture; this was followed by coverage with an intercostal muscle flap (Figs. 1a and 2a). The patient’s postoperative course was uneventful, and he continued to undergo gauze changes as an outpatient after discharge. Six months after the OWT, simple wound closure was performed under general anesthesia (Table 1).
[See PDF for image]
Fig. 1
Chest X-ray before (a) and after (b) simple chest closure
[See PDF for image]
Fig. 2
Surgical wound before (a) and after (b) simple chest closure
Table 1. Laboratory finding before simple wound closure
WBC | CRP | |
|---|---|---|
Case 1 | 7500/µL | 3.08 mg/dL |
Case 2 | 5200/ µL | 0.86 mg/dL |
Pre-closure gauze cultures showed growth of Staphylococcus aureus and Corynebacterium striatum, but air leakage was not observed. Ceftriaxone was administered perioperatively for 9 days to control infection. No bronchopleural fistula was observed during surgery, and chest closure was completed using only simple wound closure (Figs. 1b and 2b). The operation time was 48 min, with 10 mL of blood lost. Although Empyema did not recur, the patient died 15 months postoperatively from pneumonia in the left lung (Fig. 3a).
[See PDF for image]
Fig. 3
Surgery progress
Case 2
A 48-year-old man who underwent a thoracoscopic right lower lobectomy for right lower lobe lung cancer was readmitted and underwent OWT for a bronchial stump fistula. The bronchial stump in this case was closed with a 4–0 monofilament suture, followed by coverage with an intercostal muscle flap (Figs. 4a and 5a). The postoperative course...