Management of Post-lobectomy Bronchopleural: Cutaneous Fistula with a Rectus Abdominis Free Flap.

Heo, Chan Yeong; Min, Kyung Hee; Eun, Seok Chan; Baek, Rong Min; Cheon, Sang Hoon

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(6):795-798.
Published online November 1, 2009.

Management of Post-lobectomy Bronchopleural: Cutaneous Fistula with a Rectus Abdominis Free Flap.

Chan Yeong Heo, Kyung Hee Min, Seok Chan Eun, Rong Min Baek, Sang Hoon Cheon

¹Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. sceun@snubh.org
²Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula.
RESULTS
The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula.
CONCLUSION
We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.

Keywords: Bronchopleural-cutaneous fistula; Rectus abdominis free flap; Intercostal vessel