The “Bedi-IMA Buttress”: Reinforcement of the Bronchial Stump with a Pedicled Internal Mammary Artery Buttress in Diabetic Patients after Lung Resection
Objective: The development of a bronchopleural fistula is a devastating complication after lung resection. We describe a new method of buttressing the closure of the stump in diabetic patients using a pedicled internal mammary artery buttress flap to avoid a bronchopleural fistula. Methods: An internal mammary pedicled flap was used in 14 diabetic patients of lung resection to cover the bronchial stump. Results: The flap of viable vascularized muscle mass gave an excellent coverage of the bronchial stump. All patients recovered well with no bronchopleural fistula. Conclusions: We recommend this technique as a method of buttressing the bronchial stump in cases of lung resection, as the internal mammary artery is easily available and its use is not associated with any side effects.
References
[1]
Sfyridis, P.G., Kapetanakis, E.I., Baltayiannis, N.E., Bolanos, N.V., Anagnostopoulos, D.S., Markogiannakis, A., et al. (2007) Bronchial Stump Buttressing with an Intercostal Muscle Flap in Diabetic Patients. The Annals of Thoracic Surgery, 84, 967-972. http://dx.doi.org/10.1016/j.athoracsur.2007.02.088
[2]
Anderson, T.M. and Miller Jr., J.I. (1995) Use of Pleura, Azygos Vein, Pericardium, and Muscle Flaps in Tracheobronchial Surgery. The Annals of Thoracic Surgery, 60, 729-733.
http://dx.doi.org/10.1016/0003-4975(95)00500-K
[3]
Klepetko, W., Taghavi, S., Pereszlenyi, A., Birsan, T., Groetzner, J., Kupilik, N., et al. (1999) Impact of Different Coverage Techniques on Incidence of Postpneumonectomy Stump Fistula. European Journal of Cardiothoracic Surgery, 15, 758-763. http://dx.doi.org/10.1016/S1010-7940(99)00089-5
[4]
Taghavi, S., Marta, G.M., Lang, G., Seebacher, G., Winkler, G., Schmid, K., et al. (2005) Bronchial Stump Coverage with a Pedicled Pericardial Flap: An Effective Method for Prevention of Postpneumonectomy Bronchopleural Fistula. The Annals of Thoracic Surgery, 79, 284-288. http://dx.doi.org/10.1016/j.athoracsur.2004.06.108
[5]
Calafiore, A.M., Vitolla, G., Iaco, A.L., Fino, C., Giammarco, G.D., Marchesani, F., et al. (1999) Bilateral Internal Mammary Artery Grafting: Midterm Results of Pedicled versus Skeletonized Conduits. The Annals of Thoracic Surgery, 67, 1637-1642. http://dx.doi.org/10.1016/S0003-4975(99)00282-9
[6]
Prommegger, R. and Salzer, G.M. (1998) Heterotopic Ossification in Pedicled Intercostal Muscle Flaps Causing Clinical Problems. The Journal of Thoracic and Cardiovascular Surgery, 115, 466-467. http://dx.doi.org/10.1016/S0022-5223(98)70293-4
[7]
Mineo, T.C., Ambrogi, V., Pompeo, E., Cristino, B., Natali, G.L. and Casciani, C.U. (1997) Comparison between Intercostal and Diaphragmatic Flap in the Surgical Treatment of Early Bronchopleural Fistula. European Journal of Cardiothoracic Surgery, 12, 675-677.
[8]
D’Andrilli, A., Ibrahim, M., Andreetti, C., Ciccone, A.M., Venuta, F. and Rendina, E.A. (2009) Transdiaphragmatic Harvesting of the Omentum Through Thoracotomy for Bronchial Stump Reinforcement. The Annals of Thoracic Surgery, 88, 212-215. http://dx.doi.org/10.1016/j.athoracsur.2009.04.025