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Avetisyan AO, Serezvin IS, Kudriashov GG, Chausov AV, Davydenkova EA, Sokolova OP, Li VF, Stashkova KA, Yablonskii PK. The use of diaphragmatic flap for the main bronchus stump reinforcement in right-sided pneumonectomy performed for destructive pulmonary tuberculosis with drug resistance of <i>Mycobacterium tuberculosis</i>. GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-16-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
INTRODUCTION. Drug-resistant tuberculosis with subtotal and total lesion of one of the lungs is the most common indication for pneumonectomy. This operation is accompanied by a high risk of postoperative complications, among which the most dangerous is pleural empyema with bronchopleural fistula. In this regard, the prevention of this complication is an extremely important task.The OBJECTIVE was to study the results of using a diaphragmatic flap to prevent the development of right main bronchus stump insufficiency with bronchopleural fistula in patients with destructive pulmonary tuberculosis. METHODS AND MATERIALS. A retrospective study was carried out for the period from 2015 to 2019. The study included 13 patients who underwent right-sided pneumonectomy with diaphragmoplasty of the right main bronchus stump. Indications for diaphragmoplasty were: persistent bacterial excretion at the time of surgery, pre-existing bronchopleural fistula, intraoperative pleural contamination, progressive course of a specific process.RESULTS. The postoperative period was smooth in 10 (77 %) patients. Postoperative complications developed in 3 (23 %) patients: in 1 (7.7 %) case, there was right main bronchus stump insufficiency with bronchopleural fistula and in 2 (15.3 %) cases, there were right main bronchus stump insufficiency without bronchopleural fistula. A satisfactory immediate result was achieved in 12 (92.3 %) patients.CONCLUSION. The diaphragmatic flap is a reliable material for plasty of the right main bronchus stump in order to prevent the formation of bronchopleural fistula in destructive pulmonary tuberculosis.
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Affiliation(s)
| | - I. S. Serezvin
- Saint Petersburg Research Institute of Phthisiopulmonology
| | | | - A. V. Chausov
- Saint Petersburg Research Institute of Phthisiopulmonology
| | | | - O. P. Sokolova
- Saint Petersburg Research Institute of Phthisiopulmonology
| | - V. F. Li
- Saint Petersburg Research Institute of Phthisiopulmonology
| | | | - P. K. Yablonskii
- Saint Petersburg Research Institute of Phthisiopulmonology; Saint Petersburg State University
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Caushi F, Qirjako G, Skenduli I, Xhemalaj D, Hafizi H, Bala S, Hatibi A, Mezini A. Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula? J Cardiothorac Surg 2020; 15:248. [PMID: 32917252 PMCID: PMC7488725 DOI: 10.1186/s13019-020-01290-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.
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Affiliation(s)
- Fatmir Caushi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania. .,Department of Surgery, Our Lady of Good Counsel University, Tirana, Albania.
| | - Gentiana Qirjako
- Department of Public Health, University of Medicine, Tirana, Albania
| | - Ilir Skenduli
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Daniela Xhemalaj
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Hasan Hafizi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Silva Bala
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Alban Hatibi
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
| | - Arian Mezini
- Department of Thoracic Surgery, University Hospital "Shefqet Ndroqi", Tirana, Albania
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Miyata K, Fukaya M, Nagino M. Repair of gastro-tracheobronchial fistula after esophagectomy for esophageal cancer using intercostal muscle and latissimus dorsi muscle flaps: a case report. Surg Case Rep 2020; 6:172. [PMID: 32666163 PMCID: PMC7359967 DOI: 10.1186/s40792-020-00936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastro-tracheobronchial fistula after esophagectomy is a rare but life-threatening complication associated with high mortality. Several authors reported postoperative management of tracheobronchial fistula. However, treatment is demanding and challenging, and the strategy is still controversial. CASE PRESENTATION A 64-year-old man underwent thoracoscopic esophagectomy with two-field lymph node dissection and gastric conduit reconstruction by an intrathoracic anastomosis for esophageal cancer at a local hospital in June 2013. After surgery, a gastro-tracheal fistula and a gastro-bronchial fistula of the left main bronchus were diagnosed, and the patient was referred to our hospital for the management of the gastro-tracheobronchial fistula. CT and bronchoscopy and esophagogastroduodenoscopy performed at our hospital revealed that the gastro-bronchial fistula of the left main bronchus was cured by packing with the omentum from the gastric conduit and the gastro-tracheal fistula located 3 cm above the carina remained open. We concluded that the fistula would not resolve without further surgical procedure. However, such an operation was expected to be difficult and to need much time due to severe adhesion among the gastric conduit and/or trachea, bronchus, lung, and chest wall. Therefore, a two-stage operation was planned for safety and outcome certainty. The first operation was performed to close the fistula in October 2013. The gastric conduit was separated from the trachea and resected; then, the fistula was sutured and covered by intercostal muscle and latissimus dorsi muscle flaps. A month after the first operation, reconstruction with pedunculated jejunum was performed via the percutaneous route. The patient's postoperative course was uneventful. CONCLUSION If the omentum is not observed between the gastric conduit and the tracheobronchus when a gastro-tracheobronchial fistula occurs after esophagectomy, surgeons should perform surgical treatment because conservative treatment is unlikely to cure. During surgery, the use of two types of muscle flaps, such as the intercostal muscle and the latissimus dorsi muscle flaps, is helpful for the closure of gastro-tracheobronchial fistulas.
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Affiliation(s)
- Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Postpneumonectomy Bronchopleural Fistula Closure With Biologic Mesh and Diaphragm Flap. Ann Thorac Surg 2017; 104:e215-e216. [DOI: 10.1016/j.athoracsur.2017.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/26/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022]
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Sakatoku Y, Fukaya M, Fujieda H, Kamei Y, Hirata A, Itatsu K, Nagino M. Tracheoesophageal fistula after total resection of gastric conduit for gastro-aortic fistula due to gastric ulcer. Surg Case Rep 2017; 3:90. [PMID: 28831760 PMCID: PMC5567582 DOI: 10.1186/s40792-017-0371-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/17/2017] [Indexed: 12/04/2022] Open
Abstract
Background Tracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. It has a high mortality rate and often leads to severe aspiration pneumonia. Various types of surgical repair procedures have been reported, but the optimal management of TEF is challenging and controversial. Treatment should be individualized to each patient. Case presentation A 66-year-old female underwent transthoracic esophagectomy with gastric tube reconstruction and an intrathoracic anastomosis for esophageal cancer. Three years later, she had hematemesis and was diagnosed with a gastro-aortic fistula due to a gastric ulcer. She underwent endovascular aortic repair urgently at another hospital. Two days later, she underwent total resection of the gastric tube, during which time an injury to the trachea occurred; it was repaired by patching the stump of the esophagus to the injury site. Two months later, descending aortic replacement was performed due to infection of the stent graft. Six months after the first operation, a TEF developed. The patient was referred to our hospital for further treatment. The fistula was ligated and divided via a cervical approach, and a pectoralis major muscle flap was used to cover the defect. Esophageal reconstruction with the pedunculated jejunum was performed via a subcutaneous route. The postoperative course was uneventful. The patient was discharged after 6 months of physical and dysphagia rehabilitation. Conclusion A TEF located near the cervicothoracic border was successfully treated with a pectoralis major muscle flap through a cervical approach. Total resection of a gastric conduit in the posterior mediastinum carries a risk of tracheobronchial injury; however, if such an injury occurs, surgeons should be able to repair the injury using a suitable flap depending on the injury site.
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Affiliation(s)
- Yayoi Sakatoku
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hironori Fujieda
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Hirata
- Department of Surgery, Shizuoka Kosei Hospital, 23 Kitaban-cho, Aoi-ku, Shizuoka, 420-8623, Japan
| | - Keita Itatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Nachira D, Chiappetta M, Fuso L, Varone F, Leli I, Congedo MT, Margaritora S, Granone P. Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre. ANZ J Surg 2017; 88:322-326. [DOI: 10.1111/ans.13886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 07/08/2016] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | - Leonello Fuso
- Pulmonary Medicine Unit; Catholic University; Rome Italy
| | | | - Ilaria Leli
- Pulmonary Medicine Unit; Catholic University; Rome Italy
| | - Maria T. Congedo
- Department of General Thoracic Surgery; Catholic University; Rome Italy
| | | | - Pierluigi Granone
- Department of General Thoracic Surgery; Catholic University; Rome Italy
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Chichevatov D, Gorshenev A, Sinev E. Preventive Diaphragm Plasty after Pneumonectomy on Account of Lung Cancer. Asian Cardiovasc Thorac Ann 2016; 14:265-72. [PMID: 16868097 DOI: 10.1177/021849230601400401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Experience is presented of 53 cases of diaphragm plasty of the bronchial stump, tracheobronchial anastomosis, pericardium, and esophagus wall after extended pneumonectomy on account of lung cancer. A pedicled diaphragm flap was used to prevent bronchopleural fistula in 53 patients, as well as heart dislocation after wide resection of the pericardium in 26, and esophagopleural fistula after resection of the muscle coat of the esophagus in 2. In all cases, there was a high risk of these complications. Dehiscence of the bronchial stump or tracheobronchial anastomosis occurred in 9 patients, but due to diaphragm plasty, a bronchopleural fistula formed in only 3. Restoration of the pericardium and the esophageal muscle coat was successful in all cases. Overall morbidity was 22.6%, 30-day mortality was 7.5%, hospital mortality was 11.3%. Causes of death were fulminant pneumonia of the single lung, cerebral hemorrhage, pulmonary embolism, heart failure, early tumor progression, and sepsis, in one case each. The results were compared with those in 49 patients who underwent other methods of bronchial stump or tracheobronchial anastomosis reinforcement. The analysis revealed that the diaphragm flap was highly efficacious as a multipurpose plastic material.
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Affiliation(s)
- Dmitry Chichevatov
- Department of Thoracic Surgery, Penza Regional Oncology Health Center, 37a Prospect Stroitelei, 440071 Penza, Russia.
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Ayalp K, Kaba E, Demirhan Ö, Özyurtkan MO, Toker A. A late visceral hernia after diaphragmatic flap coverage of the bronchial stump. J Thorac Dis 2015; 7:E198-200. [PMID: 26380752 DOI: 10.3978/j.issn.2072-1439.2015.07.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/19/2015] [Indexed: 11/14/2022]
Abstract
A 54-year-old man presented with sudden and severe abdominal pain, and vomiting. He had underwent a right pneumonectomy with bronchial stump reinforcement using diaphragmatic muscle flap 9 years ago, due to non-small cell lung cancer after neoadjuvant chemotherapy. A right partial visceral herniation had been detected 5 years ago during the follow-up which was not present at previous visits. He had refused any surgical intervention since he had been asymptomatic. The chest computed tomography demonstrated visceral herniation. The patient underwent an urgent operation via thoracoabdominal incision to repair the herniation. This type of late catastrophic complication of diaphragmatic muscle flap reinforcement is extremely rare.
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Affiliation(s)
- Kemal Ayalp
- 1 Department of General Surgery, Istanbul Group Florence Nightingale Hospital, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Istanbul, Turkey
| | - Erkan Kaba
- 1 Department of General Surgery, Istanbul Group Florence Nightingale Hospital, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Istanbul, Turkey
| | - Özkan Demirhan
- 1 Department of General Surgery, Istanbul Group Florence Nightingale Hospital, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Istanbul, Turkey
| | - Mehmet Oğuzhan Özyurtkan
- 1 Department of General Surgery, Istanbul Group Florence Nightingale Hospital, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Istanbul, Turkey
| | - Alper Toker
- 1 Department of General Surgery, Istanbul Group Florence Nightingale Hospital, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Istanbul, Turkey
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Jabłoński S, Brocki M, Wawrzycki M, Klejszmit P, Kutwin L, Kozakiewicz M. Pericardial flap: an effective method of surgical repair of late post-pneumonectomy fistula. Surg Infect (Larchmt) 2014; 15:560-6. [PMID: 24830332 DOI: 10.1089/sur.2012.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We report our experience with the surgical closure of late post-pneumonectomy bronchopleural fistula (PBF) using our own method of coverage of the bronchial stump: Pedicled pericardial flap in combination with fibrin glue. METHODS We reviewed the surgical results of 33 patients who underwent surgical closure of PBF by thoracotomy access using three methods: Myoplasty (MYO)-12, omentoplasty (OMT)-10, and pedicled pericardial flap (PPF) with fibrin glue-11. Post-operative follow up was six months. RESULTS The patients' demography was comparable among the groups. The diameter of the fistulas ranged from 5 mm to total dehiscence. The mean time of the fistula manifestation (in weeks) was 21.5 in the MYO group, 19.50 in the OMT, and 20.1 in the PPF group. The shortest period of hospital drainage of the pleural space was noted in the PPF group. Healing of the fistula was obtained in 66.67% in the MYO group, 80% in the OMT, and 100% in the PPF group. The number of complications was similar in all groups. The hospitalization time was significantly shorter in the PPF group (13.00 d) versus the MYO group (19.58 d) and the OMT (20.01 d). Overall mortality rate was 18.18%; 33.33% of the patients in the MYO group and 20% in the OMT group died. There were no hospital deaths in the PPF group. CONCLUSION Pericardial flap supported by fibrin glue can be an effective method adjunctive to the treatment of postpneumonectomy PBF in selected patients. Compared with other methods of bronchial stump coverage (omentopasty and myoplasty), this one showed a higher percentage of healing of the fistulas and shorter duration of hospital drainage and hospitalization.
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Affiliation(s)
- Sławomir Jabłoński
- 1 Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz , Lodz, Poland
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Wang S, Liang G, Zhang Z, Ji H, Hou C, He J, Yin W. Reconstruction of the thoracic tracheal defects with portions of deepithelialized myocutaneous flaps after resection of a large tumor. Chin J Cancer Res 2013; 25:161-5. [PMID: 23592896 DOI: 10.3978/j.issn.1000-9604.2013.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. METHODS From June 2007 to June 2012, five cases of defects of the thoracic trachea were reconstructed by applying portions of deepithelialized myocutaneous flaps. The patients were 27-61 years old with 4 male cases and 1 female. The cervical trachea ranged in diameter from 4-8.5 cm with circumferences of approximately 1/3-2/5 of the bronchial circumference. RESULTS All five patients with thoracic tracheal defects after resection of a large tumor were cured of portions of deepithelialized myocutaneous flaps, with no tracheal stricture remaining and vomica successfully eliminated. During the first 1 to 3 months after the operation, bronchoscopy showed that the tracheal lumens were smooth, and the visible skin of the musculocutaneous flaps became gray and exhibited a small amount of white discharge. CONCLUSIONS Despite this being a small series and short follow-up, this thoracic tracheal reconstruction with portions of deepithelialized myocutaneous flaps shows encouraging preliminary results and could be an alternative to other methods for the treatment of carefully selected patients with thoracic tracheal defects.
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Affiliation(s)
- Susheng Wang
- Department of Plastic Surgery, The First Affiliated Hospital of Guangzhou Medical University
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11
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Llewellyn-Bennett R, Wotton R, West D. Prophylactic flap coverage and the incidence of bronchopleural fistulae after pneumonectomy. Interact Cardiovasc Thorac Surg 2013; 16:681-5. [PMID: 23357525 DOI: 10.1093/icvts/ivt002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In pneumonectomy patients, is buttressing the bronchial stump associated with a reduced incidence of bronchopleural fistula?'. Fifty-seven papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. One prospective randomized controlled trial was identified, which found significantly lower rates of bronchopleural fistula and empyema after pneumonectomy with the use of pedicled intercostal flap buttressing. Intercostal muscle flaps and pericardial flaps have been used in case series of high-risk patients, e.g. those with neoadjuvant therapy or extended resections, with low rates of subsequent bronchopleural fistulae. There is the least-reported evidence for thoracodorsal artery perforator and omental flaps. There is relatively little published evidence beyond the single randomized trial identified, with only a few comparison studies to guide clinicians. We conclude that there is evidence for flap buttressing in reducing the risk of bronchopleural fistulae after pneumonectomy in diabetic patients. Flap coverage in other high-risk situations, such as extrapleural or completion pneumonectomy, has been reported in case series with good results. Of the reported techniques, the evidence is strongest for the pedicled inter-costal flap.
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12
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Liberman M, Cassivi SD. Bronchial Stump Dehiscence: Update on Prevention and Management. Semin Thorac Cardiovasc Surg 2007; 19:366-73. [DOI: 10.1053/j.semtcvs.2007.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2007] [Indexed: 11/11/2022]
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Paulo NM, Miranda W, Atayde IB, Siqueira Junior JTD, Azevedo EMR, Lima FGD, Franco LG, Faria CMC. Reconstruction of thoracic esophagus with pediculated diaphragmatic flap in dogs. Acta Cir Bras 2007; 22:8-11. [PMID: 17293943 DOI: 10.1590/s0102-86502007000100002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 10/20/2006] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To verify whether pediculated diaphragmatic flaps were suitable to correct iatrogenic wounds in dog's esophagus injuries. METHODS Seven dogs were submitted to resection of a segment of the esophageal wall, which was then corrected by suturing a pediculated diaphragm flap. Endoscopic evaluation of the esophageal wall was done forty days after the surgical procedure. RESULTS Three animals died, one due to implant ischemia, caused by strangulation of the phrenic artery; other due to wound infection; and the last, due to mediastinitis. Scar retraction was observed, however, there was no stenosis, allowing the passage of a 9,8 mm probe with no difficulty. The limits between the implants and the native esophagus were indistinguishable, and the implant was covered by esophageal mucosa. CONCLUSION The diaphragmatic flaps are suitable on the restoring of continuity in dog's thoracic esophagus.
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Affiliation(s)
- Neusa Margarida Paulo
- Veterinary Medicine College, Federal University of Goiás, 74001-910 Goiânia, GO, Brazil. Brazil.
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Cohen M, Grevious M. The Use of Muscle Flaps for the Management of Recalcitrant Gastrointestinal Fistulas. Clin Plast Surg 2006; 33:295-302. [PMID: 16638471 DOI: 10.1016/j.cps.2005.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Enterocutaneous fistulas can result from various conditions. Although some heal spontaneously, others persist or recur. This article describes how using muscle flaps may aid in managing recalcitrant gastrointestinal fistulas. Specific cases are cited.
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Affiliation(s)
- Mimis Cohen
- Divisions of Plastic, Reconstructive, and Cosmetic Surgery, the University of Illinois, Chicago, IL 60612, USA.
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Tamesue K, Hara K, Hara F, Nakajima T. Pericardial reconstruction using a pedicle flap of the diaphragmatic central tendon. ACTA ACUST UNITED AC 2005; 53:494-7. [PMID: 16200891 DOI: 10.1007/s11748-005-0094-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 46-year-old woman was referred to our hospital for further evaluation of an abnormal shadow on a chest X-ray. Chest computed tomography and magnetic resonance imaging revealed a lobulated tumor arising from the left lower lobe. At operation, the tumor tissue was found to have invaded the lingula and pericardium, involving the left phrenic nerve. Resection of the left lower lobe, lingula and pericardium including the phrenic nerve was performed for extended pulmonary malignancy. A pedicle flap of the diaphragmatic central tendon was used as a pericardial patch for pericardial reconstruction with satisfactory results. The patient's postoperative course was uneventful. The postoperative histological diagnosis was pulmonary adenocarcinoma with sarcomatous elements [pT3N2M0]. At present, 43 months after the operation, the patient is receiving chemotherapy after having undergone cyberknife radiotherapy for brain metastasis of the tumor. The use of a pedicle diaphragmatic flap was effective in repairing a pericardial defect after extensive resection of pulmonary malignancy.
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Affiliation(s)
- Kiyokazu Tamesue
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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Katsuragi N, Nakajima Y, Shiraishi Y, Hashizume M, Takahashi N. Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2005; 53:440-2. [PMID: 16164257 DOI: 10.1007/s11748-005-0081-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraoperative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.
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Affiliation(s)
- Naoya Katsuragi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
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Lengelé B, Poncelet A, Meunier D, Elias B, El Fouly PE, Willemart G, Noirhomme P. [About the rational use of intrathoracic transfers. Anatomical and surgical bases for the selection of twelve different muscular and omental flaps]. ANN CHIR PLAST ESTH 2003; 48:99-114. [PMID: 12801550 DOI: 10.1016/s0294-1260(03)00013-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Because of their rich blood supply and of their original detersive and filling properties, the muscular pedicled flaps harvested from the trunk or the omental flap elevated from the abdomen may be very usefull to treat large defects or major septic problems in pleural, pericardic or mediastinal cavities. We here describe the main principles to be followed in such intrathoracic reconstructions performed in order to control severe mediastinites, aortic prosthetic infections, pleural empyemas and broncho-pleural, tracheo-esophageal or broncho-esophageal fistulas. In all these circumstances, the muscular or omental flaps which are transferred into the chest are selected according to the recipient field and to their respective access to the upper, middle and lower portions of the pleural space or mediastinum. Twelve different flaps so appear available to achieve the adequate reconstruction, filling or coverage of nine distinct topographic sites. Their rational use, based on various anatomical guidelines, allows to prevent or to cure efficiently 90% of the infectious or fistular complications frequently observed in the postoperative course of aggressive, functional or oncological, intrathoracic surgical procedures.
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Affiliation(s)
- B Lengelé
- Service de chirurgie plastique et de microchirurgie reconstructrice (Prof. R. Vanwijck), cliniques universitaires St-Luc, Université Catholique de Louvain, Bruxelles, Belgique.
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Toloza EM, Harpole DH. Intraoperative techniques to prevent air leaks. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:489-505. [PMID: 12469483 DOI: 10.1016/s1052-3359(02)00020-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.
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Affiliation(s)
- Eric M Toloza
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Box 3048, Durham, NC 27710, USA.
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Diaphragm flap for routine prophylactic reinforcement of bronchial stump after pneumonectomy: Reply. Ann Thorac Surg 2001. [DOI: 10.1016/s0003-4975(00)02688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chekanov VS. The use of diaphragmatic flaps in cardiac surgery. J Thorac Cardiovasc Surg 2000; 120:426-7. [PMID: 10917974 DOI: 10.1067/mtc.2000.108281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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