Muscle flap reconstruction of the post-lung resection space: clinical cases involving latissimus dorsi, serratus anterior, and pectoralis major.

Background: Chronic empyema and bronchopleural fistula (BPF) are challenging complications after lung resection, often requiring surgical solutions when conservative treatments fail. This case report contributes to the literature by illustrating tailored use of different muscle flaps-including combined serratus anterior and latissimus dorsi, as well as pectoralis major-for definitive closure of chronic post-resection spaces. Case Description: We report two cases. Case A: a 72-year-old male developed empyema three months after a left upper lobectomy for adenocarcinoma. Cultures grew Conclusions: These cases illustrate that successful outcomes in chronic post-resection empyema depend on flap choice tailored to cavity location, size, and prior surgery. Combining serratus anterior and latissimus dorsi provides sufficient bulk for extensive lateral cavities, while the pectoralis major is effective for anterior upper thoracic spaces, even in the setting of prior pneumonectomy and fistula. Careful patient selection and flap matching to defect characteristics are key to durable closure and functional preservation.