Shimizu J

Evaluation of surgical treatment of pyothorax with special reference to the usefulness of the omental pedicle flap method.

The operative results in a series of 17 patients with pyothorax were reviewed. Of these, 10 had chronic empyema (group 1), and 7 had postoperative empyema (group 2). A single-stage operation was performed in eight patients in group 1 (decortication in six, thoracoplasty in one, omental plombage in one) and in all patients in group 2 (omentopexy in five, thoracoplasty in two). Two-stage procedures were performed in two patients in group 1. We obtained favorable postoperative results in eight patients in group 1, and in four patients in group 2. In our series, good results were not obtained by thoracoplasty alone; however, satisfactory results were achieved by short-term management in patients treated with the omental method. We think this series demonstrates the value of the omental pedicle flap method, which prevents loss of function due to a defective organ and offers excellent therapeutic results following an easy operative procedure. Further active application of this method can be expected in the management of thoracic disorders.

Complete sternectomy for metastatic carcinoma with reconstruction using a latissimus dorsi musculocutaneous flap.

A 67-year-old man was hospitalized because of anterior chest pain and bulging. Histopathologic examination of a biopsy specimen revealed metastatic adenocarcinoma. For the metastatic sternal tumor a complete sternectomy was performed at all layers, following which the chest wall defect was reconstructed using no artificial materials but only a latissimus dorsi musculocutaneous flap. Postoperative respiratory function tests gave satisfactory results. This case suggests that, provided the organs within the thoracic cavity can be protected, solid or semi-solid stabilization achieved with artificial materials may not always be necessary, even in cases undergoing extensive sternectomy.