Muscle flaps in pulmonary infections: a case series from Northeast India

Abstract

Aim Treatment of complications due to pulmonary infections usually involves lung resection with or without debridement. Managing residual intrathoracic defects, chronic empyema, and bronchopleural fistulae after such resections poses unique challenges. Methods We retrospectively reviewed the data of all 9 patients referred to us with complications due to pulmonary infections, including the surgical procedures, flaps used, and their outcomes between 2018 and 2019. Results The mean age of the patients was 30 years (range 9?48 years). The primary disease was tuberculosis in 6 (66%) patients. Complications of primary infections were pneumothorax ( n = 3), auto-pneumonectomy ( n = 2), organized empyema ( n = 3), and recurrent hemoptysis ( n = 1). Initial interventions included lobectomy ( n = 2), tracheoesophageal repair ( n = 1), bronchial artery embolization ( n = 1), intercostal tube drainage ( n = 4), and decortication( n = 1). Complications after primary interventions included bronchopleural fistula ( n = 4, 45%), recurrent empyema ( n = 3, 33%), tracheal stump dehiscence ( n = 1, 11%) and non-resolving hemoptysis ( n = 1, 11%). Pathological microorganisms were isolated in 8 (88%) patients. Secondary corrective surgical interventions along with pedicled muscle flap interposition and reinforcement were undertaken. Nine flap procedures with or without thoracoplasty were performed. There was no open thoracostomy conversion. There was one death postoperatively. Conclusion A locoregional pedicled flap with or without thoracoplasty is an effective option to manage complications of pulmonary infections. The cardiothoracic surgeon should have a knowledge of the locoregional flaps of the thorax and abdomen to address such complications.