Management of postpneumonectomy empyema and bronchopleural fistula

Claude Deschamps, Mark S. Allen, Daniel L. Miller, Francis C. Nichols, Peter C. Pairolero

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Empyema after pneumonectomy is often associated with a bronchopleural fistula (BDF) and has a significant mortality. Management options include systemic antibiotics and observation, adequate pleural drainage, appropriate parenteral antibiotics, removal of necrotic tissue, and obliteration of residual pleural space. We prefer to treat the empyema with the procedure originally described by Clagett and Geraci in 1963. They demonstrated that postpneumonectomy empyema could be successfully treated by open pleural drainage, frequent wet-to-dry dressing changes, and when the thorax was clean, secondary chest wall closure with obliteration of the pleural cavity with an antibiotic solution. Failure was most often caused by a persistent or recurrent fistula. Because of this, when a BPF is present, the original Clagett technique was modified to include transposition of a well-vascularized muscle to cover the stump at the time of open drainage to prevent further ischemia and necrosis. Our preference is intrathoracic transposition of extrathoracic skeletal muscle. The goals of therapy for postpneumonectomy empyema remain a healthy patient with a a healed chest wall and no evidence of drainage or infection. Excellent results can be obtained in more than 80% of patients by using the Clagett procedure and intrathoracic muscle transposition when a BPF is present.

Original languageEnglish (US)
Pages (from-to)13-19
Number of pages7
JournalSeminars in thoracic and cardiovascular surgery
Volume13
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Bronchopleural fistula
  • Postpneumonectomy empyema
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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