A four-muscle-flap for thoracomyoplasty in patients with sacrificed thoracodorsal vessels.
Defects after prior posterolateral thoracotomy and with concomitant bronchiopleural fistula remain a challenge for the plastic surgeon. In most of the cases, the thoracodorsal artery division after posterolateral thoracotomy impairs the vascularisation supply of the latissimus dorsi, resulting in the loss of this option for closure of the pleural cavity. Therefore, the adequate filling of residual empyema space and/or surgical closure of the bronchial stump insufficiency needs additional tissue to overcome this situation. We present an alternative approach using a four-muscle-flap technique including the infraspinatus, the subscapularis and the teres major and minor muscle group, all pedicled from the subscapular artery as a part of a modified thoracomyoplasty technique for closing the residual empyema space and bronchial stump insufficiency.
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