Intercostal muscle flap for repair of bronchopleural fistula

Abstract

A 50-year-old male patient, a known case of chronic obstructive pulmonary disease (COPD), presented with the features of bronchopleural fistula (BPF) on the right side for 1 month. The patient was a chronic smoker and did not give any history suggestive of pulmonary Koch's. The patient had sudden-onset breathlessness and chest pain 1 month before, which was diagnosed to be due to spontaneous pneumothorax. An intercostal drain was inserted but even after 1 month of all conservative measures, the lung remained collapsed and there was large air leak in the intercostal drain. Computed tomogram (CT) of the chest revealed collapsed and entrapped lung with surgical emphysema of the subcutaneous tissues due to rupture of the emphysematous bulla on the right side along with the presence of emphysematous bullae on the left upper lobe also. Surgical intervention in the form of decortication of entrapped lung and repair of the BPF with intercostal muscle flap was performed. The patient recovered well and was discharged after 10 days.

Novel technique to repair a bronchopleural fistula after esophagectomy using wide intercostal muscle flap fixed by azygos vein and bronchus: a case report

“…The azygos vein supports the muscle flap holding too. Not only strong fixing of the muscle flap and fistula, but the pedicle flap can also be made to function as a healing aid that maintains blood flow by the internal thoracic artery [5]. Even if the azygos vein is transected during esophagectomy, this procedure can be done by wrapping muscles above the bronchus if the location of the fistula is the same.…”

“…However, affected patients are generally exhausted by surgical stress, the BPF, and pleural infection. Additionally, the optimal surgical procedure for BPF depends on various factors, including the size and site of the fistula, nutritional condition, and comorbidities [5]. It is extremely important that the selected surgical procedure fixes the muscle flap such that it does not subsequently collapse.…”

Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management

“…The intercostal muscle flap causes no functional disability, is easy to harvest, has adequate length to reach most sites, has adequate vascularity and is harvested through the same thoracotomy incision [39]. Sfyridis et al, discovered the group that received an intercostal muscle flap had a lower incidence of development of BPF (0% versus 8.8%; p < 0.02) [40].…”

Bronchopleural fistula treatment: From the archetype of surgery to the future of stem cell therapy

“…Bronchopleural fistula (BPF) is a pathological connection between the airway and the pleural space that may develop after lung resection[ 1 ] or following thoracic traumas, complications of infective pleuropulmonary diseases or on account of the rupture of emphysematous bullae, as reported by Goyal and collegues in the present number of Lung India. [ 2 ]…”