Empyema is a commonly encountered disease and represents a major surgical problem on account of unsettled issues in the diagnosis and treatment. Of the three phases described in this entity the final stage is phase III or chronic, which usually begins four to six weeks after the development of empyema when the lung is trapped. This chronic phase represents the source of the most of the controversy concerning treatment. Of all forms of permanent drainage of the pleural abscess we settled in a novel type of permanent drainage, i.e. a triiradiated thoracostomy which allows positioning of the flaps in any portion of the cavity, thus lining the infected pleural space. This type of window thoracostomy with three triangular flaps was first described by Galvin in 1988. We analyzed 27 patients with this process that were treated by means of a pleuro- cutaneous flap which was made resembling the Mercedes Benz automotor logo. The average age was 35.9 years, with 22 men and 5 women. The bacterial profile found was staphyloccocus aureus in 40.7% (=11), no bacteria identified in 29.6% (n=8) mixed flora 11% (n=3), E.coli 7.4% (n=2) and Proteus 3.7% (n=l). Eleven cases (40.7%) were due to trauma, pneumonia in 33.3% (n= 9); cancer 11% (n=3); tuberculosis 7.4% (n=2), postoperative and foreign body, one each 7.4% (n=2). Hospitalization time varied between three months and three days with an average of25 days. The mean time period for complete lung reexpansion was 35 days (± 10). There was no post operative death. The goals of treatment of chronic empyema, which includes control of systemic and pulmonary sepsis, drainage of pus, expansion of lung and improvement of pulmonary function, restoration of chest wall and diaphragmatic mobility were all accomplished with this simple operation. In summary, the Mercedes Benz pleurocutaneous flap allowed permanent sterilization of the empyema cavity in 27 patients in the average time period of 35 days.
Pleurocutaneous fiap; Pleural drainage; Pleural empyema