Gastric seromuscular and omental pedicle flap for bronchopleural fistula after pneumonectomy

Abstract

We report a case of postpneumonectomy bronchopleural fistula treated using a gastric seromuscular and omental pedicle flap and maintaining good postoperative respiratory function. A 76-year-old man underwent right pneumonectomy with regional lymph node dissection for squamous cell carcimoma of the lung. Five weeks later, a bronchopleural fistula occurred. Empyema with the bronchopleural fistula was diagnosed and chest tube drainage implemented immediately. Despite the drainage, signs of inflammation persisted and the patient's nutrition did not improve leading to surgery, on August 18, 1997. The bronchopleural fistula was closed by horizontal suture proximal to the stapling sutured line. A gastric seromuscular and omental pedicle flap was sutured as a cover over the bronchial stump. Postoperative analysis of respiratory function and arterial blood gas showed good results.

Closure of Duodenal Perforation by Gastric Seromuscular Advancement Flap

“…1,5,6 Gastro-omental free flaps have been used in head and neck reconstruction, to close 7 defects in the trachea, pharynx, cervical oesophagus and unfavourable hypopharynx. 8 So this study was conducted using gastric seromuscular flap to close duodenal defects taking into account that the patch would provide an anatomical barrier to the defect developing a satisfactory new mucosal barrier compared to that of omental patching.…”

Intercostal muscle flap for repair of bronchopleural fistula

“…Various flaps used for the closure of BPF and reported in the literature are intercostal muscle flap,[ 2 ] pericardial flap,[ 3 ] latissimusdorsi muscle flap,[ 3 ] serratus anterior muscle flap, rectus abdominis muscle flap and omentum. [ 4 ] The intercostal muscle flap, as was used in this case, is easy to harvest, causes no functional disability, has adequate vascularity, has adequate length to reach most of the sites and is harvested through the same incision used for thoracotomy.…”