Intrathoracic muscle flaps. An account of their use in the management of 100 consecutive patients.

One hundred consecutive patients underwent intrathoracic muscle transposition between May 1977 and February 1988. Seventy-three procedures were performed to manage the complications of infection, which included treatment of bronchopleural fistula, postpneumonectomy empyema, perforations of the heart or great vessels, and fistulae of the esophagus and trachea. Prophylactic reinforcement of the repaired viscus was done in the remaining 27 patients because of either increased airway tension or previous intrathoracic radiation. There were 71 male and 29 female patients. Ages ranged from 16 to 82 years (median, 58 years). One hundred thirty muscle transpositions were performed and included 60 serratus anterior flaps, 33 latissimus dorsi, 28 pectoralis major, 3 intercostal, 2 rectus abdominus, and 4 others. The number of operations per patient ranged from 1 to 13 (median, 2). Seventy-six complications occurred in 35 patients. There were 16 operative deaths. Follow-up ranged from 3.4 to 150.7 months (median, 41 months). Infection was controlled or avoided in 73 patients. Forty-three of the operative survivors died. Cause of death was cancer in 27 patients, cardiac in 4, pulmonary in 3, infection in 3, suicide in 1, and unknown in 5. We conclude that although associated with a significant morbidity and mortality, intrathoracic muscle transposition when there is an actual or potential leak of an intrathoracic viscus can be life saving. Long-term survival, however, is determined by the pre-existing thoracic disorder.