肩甲部皮弁（Ｓｃａｐｕｌａｒ　Ｆｌａｐ）有茎移植により，胸腔内開放後の創面の被覆開鎖に成功した右肺上葉切除後ＭＲＳＡ膿胸の１例

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  • Covering the post-thoracotomy open wound with a Scapular Flap in a patient with MRSA empyema following right upper lobectomy for multi-drug-resistent tuberculosis.

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The patient is a 62-year old man. He had active pulmonary tuberculosis since August of 1988. Because of the resistence of his bacilli against most of the potent anti-tuberculosis drugs and continual discharges of bacilli in his sputa, he was referred to our hospital for surgical treatment. Right upper lobectomy was carried out on Aug. 21, 1990 followed by thoracoplasty on Oct. 9. Unfortunately, minor bronchial fistula and MRSA empyema supervened. Since there was no improvement of the empyera with daily intrathoracic lavage, fenestrasion of the empyema space with removal of the upper 3 ribs was done on Dec. 20. With daily cleansing, the bottom of the open wound could be made shallower with some of the raw surface area of the S6 segment remaining exposed. On Apr. 16 of 1991, an attempt was made to cover this fenestration wound surface with a scapular flap measuring 14 × 8cm. With the exception of minor abscesses noted on several occasions necessitating minor drainage procedures and finally ending up as a tiny cutaneous fistula, the scapular flap successfully coverd the entire wound, including the exposed surface of the S6 segment.

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