title: Bronchial stump reinforcement with the intercostal muscle flap without adverse effects.
abstract: OBJECTIVE
  Bronchopleural fistula is a serious complication of pulmonary resection. For anatomical reasons, lower lobectomy is thought to carry a higher risk for bronchopleural fistula. We investigated the efficacy of bronchial stump reinforcement with a pedicled intercostal muscle flap after lower lobectomy and compared the responses in patients treated with the flap, without the flap, and with other types of flap. We also investigated whether harvesting the intercostal muscle flap leads to an increase in blood loss during surgery and whether the type of flap influences chest-tube volume and pain after surgery.
  
  
  METHODS
  One hundred and sixty-eight patients had lower or middle-lower lobectomy between January 1990 and December 2004. The bronchial stumps were treated in one of the three ways: covered with an intercostal muscle flap (116 patients, group A), not covered with a muscle flap (32 patients, group B), or covered with free fat or pleura (20 patients, group C). In a separate study, we compared the blood loss during surgery, and chest-tube volume and pain after surgery between patients treated with the intercostal muscle flap (23 patients) and non-intercostal muscle flap (32 patients).
  
  
  RESULTS
  No patients in group A exhibited bronchopleural fistula, and two patients in group B and one patient in group C exhibited bronchopleural fistula. These differences were not significant. Blood loss, chest-tube volume, and pain score after surgery did not differ significantly between treatment groups.
  
  
  CONCLUSIONS
  Bronchial stump reinforcement with the intercostal muscle flap after pulmonary resection is safe and effective when performed during lower and lower-middle lobectomy and does not increase the risk of complications.
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Kansai Medical University Hospital, Kansai Medical University, 10-15 Fumizono-Cho, Moriguchi, Osaka, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Maniwa
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Saito
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kaneda
authors.forename: Hiroji
authors.initials: H
authors.lastname: Imamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001980:Bronchi / Q000601:surgery*; D001982:Bronchial Diseases / Q000601:surgery*; D001983:Bronchial Fistula / Q000517:prevention & control*; D016022:Case-Control Studies; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D005402:Fistula / Q000517:prevention & control; D006801:Humans; D007366:Intercostal Muscles / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010995:Pleural Diseases / Q000517:prevention & control*; D011183:Postoperative Complications; D011446:Prospective Studies; D013524:Surgical Flaps