eMedicine Specialties > Plastic Surgery > Chest

Empyema and Bronchopleural Fistula: Follow-up

Author: Jeffrey J Rentz, MD, Fellow in Surgical Research, Wound Healing and Tissue Engineering Lab, Brigham and Women's Hospital
Coauthor(s): William G Austen Jr, MD, Assistant Professor, Department of Surgery, Harvard Medical School; Consulting Staff, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital; Suresh Koneru, MD, Clinical Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: Jun 15, 2006

Outcome and Prognosis

The underlying disease process generally limits the prognosis for patients with empyema because of bronchopleural fistula. Empyema management delays chemotherapy and radiation therapy in cancer patients. Oncologic surgery is usually not undertaken in patients with short life expectancy, but it and empyema or bronchopleural fistula can significantly reduce quality of life for patients for many months. Often, patients who develop empyemas have many comorbidities and limited potential to heal.

Empyemas are seen in community-acquired pneumonia in children. Although these patients may heal well and make a full recovery, complex wound care is more difficult and the impact of residual physical limitations is more severe.

Future and Controversies

In the future, tissue adhesives may play a more prominent role in the sealing of fistulae. Numerous case series involving fibrin sealants are reported in the literature. The most recent trend is to use bronchoscopic stents and sealants to limit contamination in combination with external drainage of the space.

In addition, as more surgeons gain expertise in microvascular techniques, free tissue transfer may become the preferred method of flap transfer. Distal flaps are less likely than regional flaps to have been compromised by previous surgeries. Distal flaps that can be harvested simultaneous to recipient vessel preparation may prove to be ideal for obliterating the space.

 


More on Empyema and Bronchopleural Fistula

Overview: Empyema and Bronchopleural Fistula
Workup: Empyema and Bronchopleural Fistula
Treatment: Empyema and Bronchopleural Fistula
Follow-up: Empyema and Bronchopleural Fistula
Multimedia: Empyema and Bronchopleural Fistula
References

References

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  8. O'Connor J, Kells, A, Henry S. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg. 2005;79(4):1196-200. [Medline].

  9. Perkins DJ, Lee KK, Pennington DG, Stern HS. Free flaps in the management of intrathoracic sepsis. Br J Plast Surg. Dec 1995;48(8):546-50. [Medline].

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Further Reading

Keywords

empyema, bronchopleural fistula, fistula, thoracic cavity, intrathoracic sepsis pleural infection

Contributor Information and Disclosures

Author

Jeffrey J Rentz, MD, Fellow in Surgical Research, Wound Healing and Tissue Engineering Lab, Brigham and Women's Hospital
Jeffrey J Rentz, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

William G Austen Jr, MD, Assistant Professor, Department of Surgery, Harvard Medical School; Consulting Staff, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital
William G Austen Jr, MD is a member of the following medical societies: American Society of Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Suresh Koneru, MD, Clinical Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Health Science Center at San Antonio
Suresh Koneru, MD is a member of the following medical societies: American Society of Plastic Surgeons and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Orgill, MD, PhD, Associate Professor, Harvard Medical School; Director, Burn Center, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Kinetic Conepts, Inc.  Consulting fee Consulting; Marine Polymers  Grant/research funds Principle Investigator; Naval Blood Research Lab Grant/research funds Principle Investigator

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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