Successful closure of postoperative bronchopleural fistulas with omental pedicle flaps in two patients with lung cancer-Measurement of blood flow in the flaps and the closed bronchial mucosa

Abstract

The omental pedicle flap is an excellent autologous tissue graft for the induction of neovascularity in avascular areas and the elimination of residual space in infected regions, because it has a dence network of blood vessels and abundant lymphatic drainage. Recently, this flap has been used in chest surgery to wrap sites of tracheobronchial reconstruction and to fill empyematous pleural cavities. Bronchopleural fistulas and empyemas that developed after surgical treatment for lung cancer were successfully closed with omental pedicle flaps in two patients. Both patients had undergone pneumonectomy with pericardiotomy and extensive dissection of regional lymph nodes, followed by postoperative radiotherapy. In order to manage the postoperative fistulas, one patient was treated by thoracoplasty and plombage with intercostal muscle flaps, and the other patient by prior open thoracic drainage. We measured the blood flow in the omental pedicle flaps and mucosa of the closed bronchial stumps by laser Doppler flowmeter before and after surgery. The blood flow in the closed bronchial stump mucosa was 35ml/min/100g on the average, and it gradually increased during the 6 months after surgery in Case 1. In Case 2, we measured the blood flow in the omental pedicle flap and the major pectoral muscle flap during surgery. The blood flow in the omental pedicle flap was 30-60ml/min/100g and was greater than that in the major pectoral muscle flap (16ml/min/ 100 g). The blood flow in the closed bronchial mucosa was 38ml/min/100g immediately after the operation.