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Free musculocutaneous flap transfer for refractory chronic empyema with chest wall sinus in a 43-year-old male with hemophilia A.

Chronic empyema combined with chest wall sinus is a refractory and agonizing disease resulting from multiple predisposing etiologies. Successful management remains challenging. Hemophilia A is a sex-linked recessive hereditary disease in which the blood does not clot normally due to lack of coagulation factor VIII and may lead to high risk of excessive surgical bleeding.