Eloesser flap

Surgical procedure for chronic empyema

The Eloesser flap is a surgical procedure used primarily in the management of chronic empyema, a condition characterized by the accumulation of pus in the pleural cavity. This procedure was developed by the American surgeon Leo Eloesser in the early 20th century and remains a significant technique in thoracic surgery.

History

The Eloesser flap was first described by Leo Eloesser in 1935. At the time, tuberculosis was a common cause of empyema, and there was a need for effective surgical interventions. Eloesser's technique provided a means to create a permanent opening in the chest wall, allowing for continuous drainage of the infected pleural space.

Indications

The Eloesser flap is indicated in cases of chronic empyema where other treatments, such as antibiotics and thoracentesis, have failed. It is particularly useful in patients who are not candidates for more extensive surgical procedures like decortication or thoracoplasty.

Procedure

The procedure involves creating a U-shaped incision in the chest wall, typically in the sixth or seventh intercostal space. The skin and subcutaneous tissue are dissected, and a flap is created. This flap is then sutured to the parietal pleura, forming a stoma that allows for continuous drainage of the pleural cavity.

Eloesser flap surgical technique

The stoma created by the Eloesser flap is designed to remain open, providing a route for drainage and preventing the re-accumulation of pus. This helps in reducing the infection and allows the lung to re-expand.

Postoperative Care

Postoperative care involves regular cleaning and dressing of the stoma to prevent infection. Patients may require long-term follow-up to monitor for complications such as infection or bleeding. In some cases, the stoma may close spontaneously once the underlying infection has resolved.

Complications

Complications of the Eloesser flap can include infection of the stoma, bleeding, and failure of the flap to provide adequate drainage. In rare cases, the procedure may need to be revised or converted to a more extensive surgical intervention.

Advantages and Disadvantages

The primary advantage of the Eloesser flap is its simplicity and effectiveness in providing continuous drainage for chronic empyema. It is less invasive than other surgical options and can be performed under local anesthesia in high-risk patients. However, it requires careful postoperative management and may not be suitable for all patients.

Related pages

• Empyema
• Thoracic surgery
• Pleural cavity
• Leo Eloesser