Giant Right Intrathoracic Myxoid Fusocellular Lipoma.

Intrathoracic lipomas are rare benign tumors; their behavior is not completely clear and their surgical removal may be challenging. We report a case of a giant right intrathoracic myxoid fusocellular lipoma compressing the lung, tracheobronchial tree, and esophagus which was removed through a posterolateral thoracotomy. Complete removal resulted in resolution of the chest pain and improvement of the dyspnea, with no recurrence at 4-year follow-up.

Muscle Flaps and Thoracomyoplasty as a Re-redo Procedure for Postoperative Empyema.

Background:  The role of muscle flaps and thoracomyoplasty in the treatment of postoperative empyema is controversial. The major difficulty is given by the sectioning of the muscular masses during the previous thoracotomy/thoracotomies, resulting in a limitation of the volume and mobility of the available neighborhood flaps.

Materials And Methods:  Between January 1, 2004, and January 1, 2012, we used muscle flaps and thoracomyoplasty as a re-redo procedure in seven patients having a history of at least two major procedures performed through thoracotomy (without considering tube thoracostomy and open thoracic window).

Thoracomyoplasty in the treatment of empyema: current indications, basic principles, and results.

Empyema remains a challenge for modern medicine. Cases not amenable to lung decortication are particularly difficult to treat, requiring prolonged hospitalizations and mutilating procedures. This paper presents the current role of thoracomyoplasty procedures, which allow complete and definitive obliteration of the infected pleural space by a combination of thoracoplasty and the use of neighbourhood muscle flaps (latissimus dorsi, serratus anterior, pectoralis, rectus abdominis, omentum, etc).

Intrathoracic transposition of the serratus anterior muscle flap--personal experience with 65 consecutive patients.

Objective: The objective of our article is to analyse the results of intrathoracic transposition of the serratus anterior (SA) muscle flap for suppurative diseases.

Method: We performed a retrospective analysis of 65 consecutive patients operated upon in our unit between 1 January 2003 and 1 March 2009 in whom we used intrathoracic transposition of the SA muscle flap. The flap was used alone or in association with other flaps and/or thoracoplasty in patients not amenable to lung resection and/or decortication, including tuberculous (TB) lesions in 30 patients (46%), postoperative empyema in 12 patients (18%), frank intrapleural rupture of a pulmonary cavity in 13 patients (20%) and bronchial fistula(e) in 26 patients (40%).

Thoracodorsal versus reversed mobilisation of the latissimus dorsi muscle for intrathoracic transposition.

Objective: The objective of our study is to perform a comparative analysis of the mobilisation of latissimus dorsi (LD) muscle flap using the primary versus secondary blood supply.

Method: Between 1 January 2003 and 1 March 2009 we used the LD muscle flap in 57 patients with different intrathoracic suppurations; these patients were divided according to the blood supply used for flap mobilisation. Group A consists of 26 patients in whom the LD was mobilised based on the thoracodorsal vessels (alone in eight patients, in combination with other flaps in 18 patients).

Complex space-filling procedures for intrathoracic infections - personal experience with 76 consecutive cases.

Objective: The objective of our article is to analyse the results of complex space-filling procedures for chronic intrathoracic suppurations.

Methods: We performed a retrospective analysis of 76 consecutive patients operated in our unit between 1 January 2003 and 31 December 2008, who presented pleural and/or pulmonary suppurations not amenable to decortication or resection; 36 patients (47%) had tuberculosis (TB) lesions (28 with positive cultures at the moment of surgery, seven with multi-drug-resistant (MDR) infections), 13 patients (17%) had postoperative empyema, 18 patients (24%) presented with frank intrapleural rupture of a pulmonary cavity and 26 patients (34%) presented with bronchial fistula. In these patients, we performed a combination of thoracoplasty (5.