Bronchial Fistula and Myoplasty

Alberto Oliaro, Enrico Ruffini, Pierluigi Filosso, Paolo Lausi, Francesco Guerrera, Stefania Olivetti, Lorena Costardi, Matteo Roffinella, Giovanni Lanza, Elisa Fontana

university of torino, torino, Italy

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

OBJECTIVE: The myoplasty is not a frequent procedure in thoracic surgery. The indications for the use of myoplasty for trachea and main bronchi are the closure of bronchial fistulas and the treatment of oesophago-tracheal fistulas. The direct closure of broncho-pleural fistulas after pneumonectomy is often impossible and has a high risk of failure due to the presence of fibrotic tissue. The muscle flap is used to achieve an indirect suture of the bronchial fistula. We present a video in which in the presence of a large and complete fistula of left main bronchus after pneumonectomy we achieved a complete closure of the bronchial fistula utilizing the serratus anterior and the latissimus dorsi muscles.

METHODS: In the first time we used the serratus anterior muscle flap in considering that the patient have undergone a posterior-lateral thoracotomy with the division of the latissimus dorsi muscle. Moreover, we performed a multiple costal resections to permit the use of the muscle flap in the residual pleural space. Unfortunately, at the CT-scans control, due to a persistent air-leak, the muscle flap not covered efficiently the fistula. Thus, we performed a further surgical revision of the pleural space and we insert a latissimus dorsi muscle flap to complete the coverage of the fistula.

RESULTS: In the post-operative days, we observed a complete resolution of air leak and the CT-scans control demonstrated a complete closure of the bronchial fistula. At the 1 year follow-up the patient is alive and in optimal clinical conditions.

CONCLUSIONS: The use of a combination of the serratus anterior and the latissimus dorsi muscle flaps could contribute to an optimal closure of the broncho-pleural fistulas after pneumonectomy.