Abstract
A 63-year-old man was admitted to our hospital for refractory empyema due to anastomotic leakage after bronchoplasty. The patient underwent distal gastrectomy for gastric ulcer and right lower sleeve lobectomy for pulmonary squamous cell carcinoma 30 and 2 years ago, respectively. The pathological stage of the patient was confirmed as stage IIB (pT2aN1M0) after the pulmonary resection, and four courses of postoperative chemotherapy with cisplatin and docetaxel were performed. Nine months after the pulmonary resection, the patient developed empyema due to bronchial anastomotic leakage. Open window thoracotomy was then performed. Although the patient's intrathoracic cavity reduced after open window thoracotomy, his dyspnea and dysphonia worsened due to exacerbation of the bronchial fistula. Therefore, the patient was referred to our hospital for thoracic stoma closure. A free left rectus abdominis musculocutaneous flap was prepared for stoma closure. A pedicle of the left inferior epigastric artery and vein was anastomosed to the right subscapular artery and vein, respectively. The free musculocutaneous flap was transposed to the thoracic cavity and the fistula was sealed with this flap. Appropriate precautions were taken to prevent occlusion of the tracheal lumen. Postoperative bronchoscopy revealed no airway obstruction due to the filling flap. Moreover, no evidence of recurrence of empyema was reported during 2 years of observational follow-up.
