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Empyema and Bronchopleural Fistula: Follow-up
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.
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References
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Garcia-Yuste M, Ramos G, Duque JL, et al. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg. Mar 1998;65(3):818-22. [Medline].
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Shaw WW, Aston SJ, Zide BM. Reconstruction of the Trunk. Plastic Surgery. 1990;6:3726-3729.
Shirakusa T, Ueda H, Takata S, et al. Use of pedicled omental flap in treatment of empyema. Ann Thorac Surg. Sep 1990;50(3):420-4. [Medline].
Further Reading
Keywords
empyema, bronchopleural fistula, fistula, thoracic cavity, intrathoracic sepsis pleural infection
Follow-up: Empyema and Bronchopleural Fistula