Decortication through muscle-sparing axillary skin crease incision (MSASCI) in late paediatric empyema thoracic

Abstract

Video-assisted thoracoscopic surgery (VATS) is a less invasive and preferred modality for early stages of empyema (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). Still, in the late organising phase, thoracotomy and decortication is the treatment of choice (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). We aimed to evaluate the results of decortications through muscle-sparing axillary skin crease incision (MSASCI) in paediatric empyema thoracic. A prospective study was conducted between July 2011 and June 2013 including 28 patients of empyema thoracic in late organising phase. Decortication was performed through MSASCI in all cases. Utility of incision was assessed in terms of intra-operative exposure, access to all the lobes, size and visibility of scar. Adequate exposure was possible in all cases. Complete excision of thickened parietal pleura with stripping of visceral peel was possible in all the cases with the release of entrapped lung. A chest tube was removed after a mean of 6.67 ± 4.62 days (5–14 days). Three patients had air leak. There were no other complications. All children had good lung expansion on chest radiography at 4 weeks. Scar was hardly visible in normal position in follow up. Muscle-sparing axillary skin crease incision is a good alternative to classical thoracotomy for decortication in paediatric age group for patients with organised empyema.