title: Intercostal muscle flap to buttress the bronchus at risk and the thoracic esophageal-gastric anastomosis.
abstract: BACKGROUND
  We assessed our outcomes using an intercostal muscle flap harvested with cautery prior to chest retraction.
  
  
  METHODS
  Our retrospective study was conducted using an electronic prospective database.
  
  
  RESULTS
  There were 456 patients (348 men) over a six year period. The intercostal muscle flap was used for bronchial coverage in 391 patients. The indications for the flap were neoadjuvant radiochemotherapy in 285 patients, infection or inflammatory disease in 106, to buttress an esophageal-gastric anastomosis in 49, and for esophageal fistula in 16. There were three bronchopleural fistulas (0.7%); one after a right pneumonectomy for tuberculosis, one after a left pneumonectomy, and one after a lobectomy in a heart transplant patient for mucormycosis. The 4-week median postoperative pain score for patients who underwent an intercostal muscle flap was lower compared with historic controls who underwent similar procedures over the same time frame but did not have an intercostal muscle flap (2.4 vs 3.7, p = 0.003). Follow-up was a median of 26 months (range, 1 to 72 months) and no patients had ossification of their flap.
  
  
  CONCLUSIONS
  An intercostal muscle flap is a versatile pedicle flap that can reach all bronchi. It is easy to harvest, adds no morbidity, and may protect the bronchi at risk. When harvested devoid of periosteum it does not ossify over time and it may reduce the pain of thoracotomy.
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama, Birmingham, Alabama 35294, USA. robert.cerfolio@ccc.uab.edu
authors.forename: Robert James
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
authors.forename: Masumi
authors.initials: M
authors.lastname: Yamamuro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001980:Bronchi / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007366:Intercostal Muscles / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D016896:Treatment Outcome