Treatment of Empyema and Bronchopleural Fistula by Bovine Pericardium and Latissimus Flap Yuan-Ming Tsai, MD, Shao-Liang Chen, MD, Chih-Ming Hsieh, MD,

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Treatment of Empyema and Bronchopleural Fistula by Bovine Pericardium and Latissimus Flap Yuan-Ming Tsai, MD, Shao-Liang Chen, MD, Chih-Ming Hsieh, MD, Cheng-Kuang Chang, MD, Ching Tzao, MD, PhD The Annals of Thoracic Surgery Volume 95, Issue 2, Pages e39-e40 (February 2013) DOI: 10.1016/j.athoracsur.2012.07.071 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Chest computed tomography image shows an empyema cavity (white arrow) with a draining chest tube in place (arrowhead) and a suspicious bronchopleural fistula (black arrow) at the lateral aspect of the right lower lobe. The Annals of Thoracic Surgery 2013 95, e39-e40DOI: (10.1016/j.athoracsur.2012.07.071) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The empyema cavity with a bronchopleural fistula (BPF) was obliterated using fibrin glue with buttressed bovine pericardium and pedicled latissmus dorsi muscle flap. (A) Thoracotomy demonstrated an empyema cavity (arrow) and a BPF (arrowhead). (B) The BPF, measuring 1.5 cm in diameter, was identified at the lateral aspect of the superior segment of the right lower lobe (arrow). (C) The BPF was sealed using fibrin glue, followed by buttressing with a piece of bovine pericardium (arrow). (D) The pedicled right latissimus dorsi muscle flap was prepared, and then (E) it was transposed to fill the empyema cavity. The Annals of Thoracic Surgery 2013 95, e39-e40DOI: (10.1016/j.athoracsur.2012.07.071) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions