title: Reconstructive Surgery for Bronchopleural Fistula and Empyema: New Application of Free Fascial Patch Graft Combined with Free Flap.
abstract: BACKGROUND
  Postoperative bronchopleural fistula (BPF) and empyema are not uncommon after lung cancer surgery. Some patients require reconstructive surgery to achieve wound healing. In this report, we describe a novel method of reconstructive surgery for BPF and empyema.
  
  
  METHODS
  From 1996 through 2014, we performed reconstructive surgery for the treatment of BPF and empyema in 13 cases. BPF or a pulmonary fistula was present in 11 patients at the time of reconstruction. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. Medical records were retrospectively reviewed, and postoperative results were compared for these methods.
  
  
  RESULTS
  All the flaps were transferred successfully except in 1 case. Although postoperative air leakage was observed in 5 cases, most of these healed with conservative management. Of 11 fistulas, 8 were successfully controlled. Although differences were not statistically significant, a higher success rate of fistula closure was obtained in patients with a fascial patch graft (100% vs 40%). As a result, 9 patients could be discharged from the hospital, but 4 died during their hospital stay.
  
  
  CONCLUSIONS
  Although the incidence of in-hospital mortality was high, fistula closure with a fascial patch graft combined with free flap transfer was effective for the treatment of BPF and empyema, compared with other procedures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Umezawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Higashino
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Oshima
authors.affiliation: Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Morioka, Japan; Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; and Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuboi