Middle lobe preserving right lower lobectomy with a serratus anterior hammock flap in a patient with previous right upper lobectomy

Increasingly, many patients are diagnosed with a second lung cancer after curative thoracotomy. It is very difficult to manage such patients surgically due to the significant loss of pulmonary function. Especially on the right side, avoiding a completion pneumonectomy may contribute to reducing postoperative functional loss and surgical complications as well as the morbidity of post-pneumonectomy syndrome. A technique is needed to prevent torsion of the preserved middle lobe. Following recently published cases utilizing a latissimus dorsi muscle flap, in this case report, we describe the use of the serratus anterior muscle flap as an alternative.