ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The Past and Present of Eloesser Flap in the Treatment of Empyema
Altuğ KOŞAR, Celal UZUN, Canan ŞENOL, Muharrem ÇELİK, Aziz UYSAL, Murat KELEŞ, Bülent ARMAN
Heybeliada Göğüs Hastalıkları ve Göğüs Cerrahisi Merkezi
Eloesser flap has been discribed firstly by Leo Eloesser in 1930 and used commonly in the management of acute tuberculous empyema. Recently, it has restricted to the treatment of chronic empyema. The purpose of this method is to accelerate the sterilizastion and obliteration of the cavity by irrigation and debridment and to prevent the aspiration of empyema material to the contrlateral lung providing more effective drainage especially in cases with bronchopleural fistula.

In this study, 13 patients who were applied Eloesser flap because of chronic empyema were reviewed in respect to the indications and results of the procedure. Six of the cases (46.2 %) underwent this procedure because of postpnemonectomy empyema and three of them had bronchopleural fistula in addition to empyema. In the remaining 7 cases (53.8 %) with chronic empyema, Eloesser flap was employed considering no possibility of decortication, resection or thoracoplasty because of bilateral parenchymal tuberculosis, nutritional efficiency or limited pulmonary functions. The negative results in pleural fluid cultures were obtained in all cases with irrigation and debrdment in 4.3 weeks (2-6 weeks). Empyema cavity was obviously obliterated radiologically in only 7 cases (53.8 %) in the follow-up period of 9 months meanly. However, it did not close completely in any of 13 cases. In addition, fistula did not closed in any cases with bronchopleural fistüla.

The most of the cases needed additional procedures for a curative treatment. Myoplasty was performed in 4 cases, thoracoplasty was performed in 3 cases. Six cases were discharged by considering reevaluation of them when they had stabile general status to tolerate a major procedure.

In conclusion, Eloesser flap is not a curative procedure in the management of chronic empyema and bronchopleural fistula. It helps sterilisation and obliteration of empyema cavity. By decreasing cavity, it gives a chance of myoplasty to the patients instead of more destructive and complicated precedure such as thoracoplasty. It should be used as a palliative method in cases that can not tolerate these operations and preferred in chronic empyema cases if an effective drainage is not possible with closed tube thoracotomy.

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