title: Pedicled latissimus dorsi muscle flap: routine use in high-risk thoracic surgery.
abstract: Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy was performed because of necrotizing, localized Mycobacterium avium-intracellulare infection. One patient underwent right upper lobectomy and main-stem bronchoplasty for carcinoma after chemoradiation therapy. In 3 patients, the pedicled latissimus dorsi muscle was used to obliterate chronic empyema cavities and to buttress the closure of underlying bronchopleural fistulas. No operative deaths or recurrent empyemas resulted. Two patients retained peri-flap air that required no surgical intervention. We conclude that the use of transposed pedicled latissimus dorsi muscle flap effectively and reliably prevents clinically overt bronchopleural fistula and recurrent empyema. We advocate its routine use in first-time and selected reoperative thoracotomies in patients who are undergoing high-risk lung resection or reparative procedures.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA. aabolhod@uci.edu
authors.forename: Amir
authors.initials: A
authors.lastname: Abolhoda
authors.forename: Trung D
authors.initials: TD
authors.lastname: Bui
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Milliken
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
mesh_terms: D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011013:Pneumonectomy / Q000009:adverse effects*; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013524:Surgical Flaps; D013908:Thoracotomy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Eur J Cardiothorac Surg. 2000 Nov;18(5):519-23
references.pmid: 11053810
references.citation: Scand J Plast Reconstr Surg Hand Surg. 2003;37(4):220-4
references.pmid: 14582754
references.citation: Asian Cardiovasc Thorac Ann. 2005 Sep;13(3):211-6
references.pmid: 16112990
references.citation: Jpn J Thorac Cardiovasc Surg. 2000 Aug;48(8):536-9
references.pmid: 11002589
references.citation: Eur J Cardiothorac Surg. 2008 May;33(5):928-30
references.pmid: 18325776
references.citation: J Thorac Cardiovasc Surg. 1995 Oct;110(4 Pt 1):1118-24
references.pmid: 7475140
references.citation: Tohoku J Exp Med. 1992 Nov;168(3):507-13
references.pmid: 1304657
references.citation: Ann Plast Surg. 2000 Nov;45(5):560-4
references.pmid: 11092371
references.citation: Ann Thorac Cardiovasc Surg. 2001 Dec;7(6):330-6
references.pmid: 11888471
references.citation: Nihon Kyobu Geka Gakkai Zasshi. 1989 Mar;37(3):498-503
references.pmid: 2768924
references.citation: Eur J Cardiothorac Surg. 1995;9(9):479-82
references.pmid: 8800695
references.citation: Semin Thorac Cardiovasc Surg. 2001 Jan;13(1):3-7
references.pmid: 11309718
references.citation: Ann Surg. 1990 Jun;211(6):656-60; discussion 660-2
references.pmid: 2357128
references.citation: Ann Thorac Surg. 2004 Feb;77(2):397-404; discussion 405
references.pmid: 14759404
references.citation: J Thorac Cardiovasc Surg. 2002 Dec;124(6):1235-6
references.pmid: 12447194
references.citation: Osaka City Med J. 1994 Dec;40(2):99-105
references.pmid: 7862430
references.citation: Arch Bronconeumol. 2000 May;36(5):251-6
references.pmid: 10916665
references.citation: Ann Thorac Surg. 2001 Jul;72(1):243-7; discussion 248
references.pmid: 11465187
references.citation: Eur J Cardiothorac Surg. 2002 Jan;21(1):74-8
references.pmid: 11788261
references.citation: Chest Surg Clin N Am. 1996 Aug;6(3):501-18
references.pmid: 8818418
references.citation: Ann Thorac Surg. 2005 Sep;80(3):1017-20
references.pmid: 16122476
references.citation: Ann Thorac Surg. 1991 Jan;51(1):157-8
references.pmid: 1985562
references.citation: Ann Plast Surg. 1999 Nov;43(5):484-92; discussion 492-3
references.pmid: 10560863
references.citation: Chest. 1990 May;97(5):1235-8
references.pmid: 2331919