THE PECTORAL MUSCLE FLAPS IN THE TREATMENT OF BRONCHIAL STUMP FISTULAFOLLOWING PNEUMONECTOMY

Between 1975 and June 1992, pneumonectomy was performed in 594 patient s, of whom 33 (5.6%) developed bronchopleural fistulae postoperatively . Until 1989 25 cases were reoperated: 5 patients were treated by thor acoplasty primarily, 20 by repair of the stump with sutures and by cov ering the stump with pericardial tissue or intercostal muscle, of whom 10 suffered from empyema. In 5/20 patients (25%) chronic fistulae dev eloped making further interventions necessary. Since 1989 seven patien ts with bronchial stump fistulae have been reoperated with a delay of less than 12 h after diagnosis. Surgery consisted of reclosure of the stump with sutures in five patients. In addition, every patient was tr eated with the intrathoracic transposition of a petiolated ipsilateral pectoral muscle graft, which was the only treatment in two patients. Neither recurrence of the bronchopleural fistula nor empyema was seen in this group of patients (0%). We conclude that bronchial stump fistu lae in patients after pneumonectomy can be treated successfully by the use of pectoral muscle flaps either combined with a closure of the le ak using sutures or as the only measure. The method proved to be simpl e, safe and without major impairment of the patient. In combination wi th early reintervention, postpneumonectomy empyema including a disfigu ring thoracoplasty can thereby often be avoided.