title: Bronchial stump buttressing with an intercostal muscle flap in diabetic patients.
abstract: BACKGROUND
  The development of a bronchopleural fistula (BPF) is a devastating complication after lung resection. Diabetic patients exhibit a high propensity for postpneumonectomy complications, particularly BPF. This study evaluated the use of an intercostal muscle flap to reinforce the bronchus in high-risk diabetic patients after pneumonectomy.
  
  
  METHODS
  From February 2002 to December 2005, 70 patients with established diabetes mellitus undergoing pneumonectomy were prospectively enrolled in this study. Patients were randomized to have their bronchial stump reinforced with an intercostal muscle flap or to a conventional resection. A univariable statistical analysis was performed to assess differences in perioperative variables and in outcomes of interest. A multivariable logistic regression analysis was also performed to evaluate the association of BPF development with a number of confounding variables, including intercostal muscle flap usage.
  
  
  RESULTS
  Randomization ensured that groups were equally distributed. Mean follow-up was 18 +/- 9.2 months. The group that received an intercostal muscle flap had a lower incidence of BPF development (0% versus 8.8%; p = 0.02) and of empyema (0% versus 7.4%; p = 0.05) compared with the group that received conventional pneumonectomy.
  
  
  CONCLUSIONS
  The low incidence of BPF and empyema observed in patients who received an intercostal muscle flap suggest that bronchial stump reinforcement with this technique is a highly effective method for the prevention of BPF in high-risk diabetic patients.
authors.affiliation: Department of Thoracic Surgery, Metaxa Anticancer Hospital, Piraeus, Greece.
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Sfyridis
authors.forename: Emmanouil I
authors.initials: EI
authors.lastname: Kapetanakis
authors.forename: Nikolaos E
authors.initials: NE
authors.lastname: Baltayiannis
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Bolanos
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Anagnostopoulos
authors.forename: Antonios
authors.initials: A
authors.lastname: Markogiannakis
authors.forename: Antonios
authors.initials: A
authors.lastname: Chatzimichalis
mesh_terms: D000368:Aged; D001980:Bronchi / Q000601:surgery*; D001983:Bronchial Fistula / Q000517:prevention & control; D048909:Diabetes Complications / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007366:Intercostal Muscles; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013524:Surgical Flaps