J Chest Surg.  2021 Apr;54(2):137-142. 10.5090/jcs.20.144.

Modus Operandi: Irrigation of the Modified Eloesser Flap in Heterogeneous Suppurative Lung Pathologies

• Vishnu R
• Rai GD
• Kamath GS
• Kumara V

• KMID: 2514609
• DOI: http://doi.org/10.5090/jcs.20.144

Abstract

Background
Refractory empyemas with collapsed lung and persistent bronchopleural fistulas pose significant problems to thoracic surgeons and impose a substantial burden in terms of morbidity and mortality. The modified Eloesser flap procedure is a useful palliative option for clearing infections. Herein, we present our experiences with the modified Eloesser flap procedure in mixed suppurative lung pathologies with a new technique of irrigation for persistent infection.
Methods
A retrospective review was carried out of 56 patients who underwent the modified Eloesser flap with continuous irrigation at Katurba Medical College. These patients had severe morbidities and were not suitable for major thoracic resection surgery, and electively underwent modified Eloesser flap surgery. Regular follow-up was done at 1, 3, 6, and 12 months. Patients with persistent infections were treated with our continuous irrigation technique.
Results
The most important finding was that all patients with active sputum acid-fast bacilli–positive findings became sputum smear–negative during the first month of follow-up. Half (50%) of the patients had a patent stoma. Eleven patients had persistent infections, necessitating continuous irrigation. The infection was fully cleared after 1 month in 9 patients, while 2 patients required second irrigation and continued to receive follow-up. In the remaining 50% of the patients, the stoma closed completely, and the lung expanded fully.
Conclusion
The modified Eloesser flap is a simple procedure. In suppurative pathologies, infections were well controlled and the general condition of the patients improved. Our continuous irrigation method showed promising results in patients with persistent purulent discharge.

Keyword

Modified Eloesser flap; Lung disease; Therapeutic irrigation; Thoracic empyemas tuberculosis; Povidone-iodine