Post-pneumonectomy Empyema: Are Eloesser Flap and Clagget

Post-pneumonectomy Empyema:
Are Eloesser Flap and
Clagget Window History?
Walter Weder, MD, Professor of Surgery
Head of Division of Thoracic Surgery, University Hospital Zurich
The clagett window
Would you like to live with this?
Chronic postpneumonectomy empyema
1995:
 33-year-old woman with
postpneumonectomy-empyema
(multiresistant pseudomonas)
 Lower lobe-resection at age 7
 Completion pneumonectomy
at age 14
 Empyema since age 18
Accelerated treatment of PPE
Zurich - concept
1. Antibiotics, optional drainage for 24 – 48 h
2. Thoracotomy, Debridement
Filling of cavity with gauze, soaked in diluted
povidone iodine, drainage, closure of chest
3. Repeat step 2 every 48 – 72 h (1 to 3 times)
Closure of BPF during step 2
With intrathoracic gauzes
(patient extubated)
After definitive
closure
/
Management of BPF
Techniques used:

Direct closure (PDS 4.0)

Shortening of the bronchus and closure by stapling
or suture

Sleeve resection of the carina with tracheobronchial
anastomosis

Indirect closure with omentum as patch
Cover BPF with well vascularized tissue
(omentum, muscle)
Management of late BPF
Clagett-window with BPF for 16 years
Film