The Role of Intrathoracic Free Flaps for Chronic Empyema

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The Role of Intrathoracic Free Flaps for Chronic Empyema Mark D. Walsh, MD, Anthony D. Bruno, MD, Mark W. Onaitis, MD, Detlev Erdmann, MD, PhD, Walter G. Wolfe, MD, Eric M. Toloza, MD, L. Scott Levin, MD, FACS The Annals of Thoracic Surgery Volume 91, Issue 3, Pages 865-868 (March 2011) DOI: 10.1016/j.athoracsur.2010.10.019 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Implantable Doppler probes were used to monitor the vascular anastomoses in the immediate postoperative period. The Annals of Thoracic Surgery 2011 91, 865-868DOI: (10.1016/j.athoracsur.2010.10.019) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Use of an atriovenous loop with the saphenous vein to obtain adequate length for anastomosis of the free rectus abdominis flap using the thoracoacromial artery and azygous vein. Anastomoses to the thoracoacromial artery and azygous vein were performed and the saphenous vein was allowed to dilate. The saphenous vein was then divided at its midpoint. The arterial limb was used for inflow to the flap and the venous limb used for venous drainage of the flap. Shown is the loop before saphenous vein division. Future sites of inflow and outflow are labeled. The Annals of Thoracic Surgery 2011 91, 865-868DOI: (10.1016/j.athoracsur.2010.10.019) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Flow chart demonstrating decision algorithm for post-resection empyema. (BPF = bronchopleural fistula.) The Annals of Thoracic Surgery 2011 91, 865-868DOI: (10.1016/j.athoracsur.2010.10.019) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Total intrathoracic placement of the rectus abdominis muscle for obliteration of dead space. The flap was anastomosed to the thoracodorsal vessels. The Annals of Thoracic Surgery 2011 91, 865-868DOI: (10.1016/j.athoracsur.2010.10.019) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions