Staged closure of complicated bronchopleural fistulas

Bronchopleural fistulas remain a major complication after thoracic-surgery, Despite continued advances in the treatment of this difficult problem, per ioperative mortality remains as high as 15%, Multiple treatment strategies have been described with varying degrees of success. Successful treatment o f chronic bronchopleural fistulas requires aggressive control of infection, adequate drainage of the chest cavity, closure of the fistula with vascula rized tissue, and obliteration of the chest cavity, The authors present the ir experience with 3 patients who underwent a two-stage closure of their br onchopleural fistulas with pectoralis major muscle flaps followed by omenta l flap obliteration of the chest cavity, Each patient had previously underg one an Eloesser procedure for chest cavity drainage. The initial muscle fla p operation is a small procedure that can be done rapidly with minimal morb idity-in chronically ill patients. The intervening period between procedure s allows patients to continue aggressive nutritional and physical rehabilit ation until they are able to tolerate a second operation for chest cavity o bliteration. All bronchopleural fistulas in our series healed, with one min or complication. A staged closure is a safe and effective alternative treat ment for chronic and recurrent bronchopleural fistulas.