Figure 2.

(A) Patient was unhappy with Eloesser flap for drainage of empyema cavity. (B) Upper four rib thoracoplasty was done to help close down the apex of the pleural space. (C, D) Contralateral composite extended latissimus dorsi and serratus anterior musculocutaneous flap was elevated on a single thoracodorsal vascular pedicle. (E) Remaining dead space obliterated with latissimus muscle, and bronchial repair buttressed with serratus anterior. Skin island is external. (F) Patient has no external chest wall deformity, and his ability to climb stairs is greatly improved with no further “escape” of inspired air through the fistula.