Vertical Axillary ‘Muscle Sparing’ incision in empyema; Early results

Background There are very few studies in literature which have reported a vertical incision thoracotomy for empyema cases. We hereby present our initial experiences using this approach. Methods 22 patients with empyema were selected for thoracotomy via the vertical incision which ran along the posterior axillary fold from axilla to the iliac crest. Lattisimus dorsi and serratus anterior were mobilized along their whole lengths. Decortication was done by standard procedure which if failed, thoracoplasty was done and mobilized muscle flap was inserted into the cavity to obliterate it. If bronchopleural fistula was present, it was sutured using the same myoplastic flap. Results Complete obliteration of the cavity was achieved in all patients with no residual collection. The success rate was 100% in closure of bronchopleural fistulae. No open drainage was required and the procedure was completed in one stage. Conclusions Based on our initial experience, this approach seems to be safe and practical in empyema cases. It gives us better cosmetic results and minimum postoperative morbidity.