Intrathoracic Muscle Flaps

From 1977 to 1987, 87 consecutive patients underwent intrathoracic muscle transposition. Indications for the operation were bronchopleural fistula, postpneumonectomy empyema, perforation of the heart or great vessels, esophageal fistula, tracheal fistula, empyema, and prophylactic reinforcements of the airway. Of the 118 muscles transposed, the serratus anterior was used in 48 patients, the latissimus dorsi in 33, the pectoralis major in 26, and other muscles in 11. Depending on the wound status at the time of muscle transposition, the chest either was left open for dressing changes or was closed primarily. The number of operations per patient ranged from 1 to 16 (median 2). There were 13 operative deaths (14.9 percent). The follow-up period ranged from 3.9 to 130.9 months (median 28.3 months). Overall results were excellent in 65 patients (74.7 percent). There was no difference in results when considered according to treatment indication. We conclude that when there is an actual or potential leak of the tracheobronchial tree, heart and great vessels, or intrathoracic gastrointestinal tract, intrathoracic muscle transposition can be a lifesaving adjunct.