PURPOSE: The mortality rate of a bronchopleural fistula associated with alung resection is as high as 30–40%. A Bronchial fistula is more common following induction chemo/radiation therapy. We studied the protective role of a vascularized pedicle muscle flap from the diaphragm in promoting healing of the bronchial stump and preventing a bronchopleural fistula.
METHODS: Over a 4 year period 17 high risk patients underwent placement of a vascularized pedicle of diaphragmatic muscle onto the bronchial stump. High risk for bronchial fistula was determined by induction chemo/radiation therapy or the presernce of pleural infection. The pedicle diaphragmatic muscle flap was harvested from the ipsolateral hemidiaphragm and based on a branch of the phrenic artery. The phrenic nerve was preserved. The diaphragm was repaired primarily.
RESULTS: There were 13 men, 4 women. Mean age 58.9 yrs. 8/17(47%) had preoperative chemo/radiation therapy, 1/17 (6%) had pleural space infection at the time of resection and in the remaining 8/17(47%) it was anticipated they would need adjuvant therapy after surgery. Distribution of procedures: Pneumonectomy 6, Bilobectomy 4, single lobectomy 7. There were 10 ACA, and 7 SCCA. 2/17 (12%) patients had air leak postop which resolved spontaneously. Postoperatively,the ipsilateral hemidiaphragm was functional in all patients. Follow up was complete in all patients. There was no bronchopleural fistula. There were no postoperative deaths. 13/17 (76%) were alive at the time of followup.
CONCLUSION: A vascularized pedicle muscle flap of the diaphragm promotes healing of the bronchial stump and prevents a bronchopleural fistula in high risk patients following pulmonary resections. Diaphragmatic function remains intact following the harvest of the pedicle muscle flap.
CLINICAL IMPLICATIONS: Bronchial stump coverage with a vascularized pedicle muscle flap of the diaphragm should be considered in all patients who are at high risk for a bronchial stump fistula.
DISCLOSURE: Farid Gharagozloo, None.