Plasty of a large through thoracic wall defect with the help of VRAM-flap: a clinical case

At present, there is a fairly large number of surgical interventions, both open and video-assisted thoracoscopic, on the chest organs in oncopathology and pulmonary tuberculosis, as well as in various pyoinflammatory and nonspecific diseases of the lungs and pleura. However, a consequence of the increase in surgical activity is an increase in the number of postoperative complications, the most severe of which are bronchopleural complications. The management of patients with inadequate sealing after lung resection is one of the most common problems in thoracic surgery. Thoracostomy is still actively used in patients with a long-term residual pleural cavity with a volume of more than 1 / 3 of the hemithorax, with the ineffectiveness of the measures taken to achieve aerostasis (change of active and passive aspiration, pneumoperitoneum, chemical pleurodesis), in the absence of the effect of closed drainage, videothoracoscopy, and with the further development of empyema. Thus, surgical treatment of lung pathology on the background of local infectious process and delayed lung expansion on the background of COPD is largely associated with the risk of complications. One of them is the empyema of the pleura, which, in this clinical case, was complicated by severe osteomyelitis of the ribs, requiring several thoracoplasties with the appearance of large thoracostomy. One of the methods for treatment of such defects is flap plastics. In the presented clinical case, thoracostomy surgery of the right hemitorax was performed with a vertical flap on the rectus abdominis (VRAM-flap).