Paraspinous muscle flap for the treatment of an empyema cavity: three case reports.

A surgical option is commonly chosen when conservative medical therapy for empyema is impossible. The muscles used include the latissimus dorsi, trapezius, and pectoris major, based on the size and location of the empyema cavity. However, these volumes are decreased in patients suffering from malnutrition, and flap dissection and elevation are sometimes invasive. Therefore, we developed an alternative method, and present three successful cases in which we used a pedicled paraspinous muscle flap to fill the dead space caused by empyema fenestration in the medial region of the back. The paraspinous muscle flap remains an important tool in reconstruction. However, such flaps should be created only in selected cases, such as those with empyema in the posterior region. Also, if the pleural space is large, additional muscle flaps will be required.