Intercostal Muscle Flap in Post Tuberculous Pneumonectomy: A New TechniqueReport as inadecuate




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Objective: There are many risk factors for postoperative bronchopleural fistula BPF, including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiotherapy, the risk of bronchopleural fistula increases with resection for inflammatory diseases, especially Mycobacterium tuberculosis MTB. The aim of this study is to evaluate the efficacy and safety of using double pedicled intercostal muscle flaps with dual blood supply to buttress the bronchial stump after pneumonectomy for tuberculous lesions as a prophylactic new technique from post-pneumonectomy BPF. Methods: Between 2007 and 2011, 47 patients with pneumonectomy for post tuberculous lesions in the department of cardiothoracic surgery, Zagazig University Hospital were divided into two groups. Group A: 28 patients with single pedicled intercostal muscle flap used and applied on the bronchial stump after pneumonectomy. Group B: 19 patients with double pedicled intercostal muscle flaps used and applied on the bronchial stump. The mean age of the patients was 42.9 years range 27 - 67 years in Group A, 44.8 years range 36 - 71 years in Group B. Results: Bleeding in one patient in Group A 3.5% and two patients in Group B 10.5%; empyema in two patients 7.1% in Group A only one of them developed bronchopleural fistula; arrhythmias in one patients 3.5% in Group A and one patient in Group B 5.2%; chylothorax in one patients 3.5%; Chronic chest pain in one patient in Group A 3.5% and two patients in Group B 10.5%. The mean follow up period was 32.7 ± 12.9 months range between 3 and 48 months. All patients remained symptom free with no evidence of late bronchopleural fistula in Group B. Conclusions: Double pedicled intercostal muscle flaps with dual blood supply buttressing the bronchial stump is new prophylactic technique from BPF after pneumonectomy for pulmonary tuberculous lesions in high risk patients.

KEYWORDS

Intercostal Muscles; Pneumonectomy; Tuberculosis

Cite this paper

A. Brik, A. Salem and O. Saber -Intercostal Muscle Flap in Post Tuberculous Pneumonectomy: A New Technique,- Surgical Science, Vol. 3 No. 5, 2012, pp. 249-252. doi: 10.4236-ss.2012.35049.





Author: Alaa Brik, Abdel-Maged Salem, Osama Saber

Source: http://www.scirp.org/



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