Successful use of an omental pedicled flap for obliterating empyema associated with a large bronchial fistula

We transferred the omentum up into the thorax through the diaphragm and succeeded in obliterating the empyema with a large bronchial fistula. A 52 year-old man with 30 years history of empyema was referred because of purulent discharge through the cutaneous fistula starting one year before. Open thoracotomy revealed a round opening 13 mm in diameter to the cavity, which resulted from lobectomy performed 30 years before. After a month of dress changing pseudomonas aeruginosa in the empyema space disappeared. Thereafter radical operation was performed in order to close the fistula. The omental flap supplied by the right gastroepiploic artery was transferred into the empyema space. The flap was sutured to the orifice of the bronchial stump. The residual space was obliterated by the thoracoplasty using the chest wall with ribs and lateral side of the empyema wall. Postoperative course was uneventful and bronchoscopy at two months after the operation revealed that the bronchial mucosa developed and covered over the large bronchial fistula.