title: Clinical results of bronchial stump coverage using free pericardial fat pad.
abstract: Bronchial fistula is a severe complication after thoracic surgery. Although many methods of coverage using various autologous tissues including pedicled pericardial fat pad have been reported to be useful for the prevention of bronchial fistula, the ideal roles of these approaches and the coverage techniques yielding the best results still remain unclear. The clinical use of an autologous free fat graft has been reported in the various surgical fields including otolaryngology, orthopaedics and plastic surgery. Therefore, we have used a free pericardial fat pad (FPFP) as the material for covering the bronchial stump instead of a pedicled pericardial fat pad.
  
  
  
  Between January 2009 and December 2013, 1134 patients with lung cancer underwent pneumonectomy or lobectomy without bronchoplasty at our institution. Among them, 46 patients underwent bronchial stump coverage using a FPFP and we investigated the clinical results obtained retrospectively.
  
  
  
  Bronchial fistula occurred in 5 patients during the study period. Although we performed bronchial stump coverage mainly in patients with several risk factors for bronchial fistula, no bronchial fistula developed in this group. To investigate the viability of the FPFP, we examined the fat tissue around the bronchial stump demonstrated by chest computed tomography retrospectively. Although fat tissue at the bronchial stump gradually decreased in size, it remained evident for 5 months and was identified in almost half of the patients even at 1 year after surgery.
  
  
  
  No bronchial fistula developed in the FPFP group. Although the FPFP is a free flap, it remains viable for many months after surgery and may contribute to good wound healing of the bronchial stump by offering a wet environment. A pericardial fat pad is easy to make, can be used anywhere in the thoracic cavity and may be useful for bronchial stump reinforcement.
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan katccha@ares.eonet.ne.jp.
authors.forename: Katsunari
authors.initials: K
authors.lastname: Matsuoka
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Imanishi
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuoka
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Nagai
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Ueda
authors.affiliation: Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
mesh_terms: D000273:Adipose Tissue; D000368:Aged; D001980:Bronchi / Q000601:surgery; D001983:Bronchial Fistula / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Bronchial fistula; Lung cancer surgery; Pericardial fat pad