Pedicled intercostal muscle flap for bronchus fistula prevention and treatment.

Bronchus fistulae are rare, but a severe complication after a radical lung cancer surgery. In our opinion, pedicled intercostal muscle flap is simple and effective method for prevention and/or treatment of a bronchus fistulae. During the last 5 years (2012 - 2017) 29 patients underwent VATS with intercostal flap procedure. Indication for flap surgery was postoperative bronchus fistula (6), bronchus sleeve insufficiecy (1) (Pict.1.) and a prophylactic bronchus (stump/sleeve) cover (22). Patient characteristics, long-term outcome and postoperative complications were evaluated by analysing patient medical entries and surgical reports. The mean age of the patients was 64.4+/-5 years. The mean VATS lobectomy time with bronchus covering for neo-adjuvantly treated patients was 218 minutes; furthermore, routine VATS lobectomy time was 150 minutes. There were no deaths after intercostal muscle flap surgery; postoperative stay was 12 days (9-28 days). All patients were re-evaluated postoperatively and showed no signs of fistula recurrence. Our study showed that plastic-reconstructive flap surgery with intercostal muscle flap is a simple and safe procedure. It could be performed during VATS anatomical resection as prophylactic step; this would increase the operation time by 15 minutes however minimise postoperative fistulae rate in high risk patient group. This method is also effective for the treatment of postoperative bronchial fistulae.