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. 2020 Apr;145(4):829e-838e.
doi: 10.1097/PRS.0000000000006670.

Muscle Flap Transposition for the Management of Intrathoracic Fistulas

Malke Asaad  1 , Amelia Van Handel  1 , Arya A Akhavan  1 , Tony C T Huang  1 , Aashish Rajesh  1 , Mark A Allen  1 , K Robert Shen  1 , Basel Sharaf  1 , Steven L Moran  1
Affiliations

Muscle Flap Transposition for the Management of Intrathoracic Fistulas

Malke Asaad et al. Plast Reconstr Surg. 2020 Apr.

Abstract

Background: Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas.

Methods: A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed.

Results: A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment.

Conclusions: Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving.

Clinical question/level of evidence: Therapeutic, III.

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References

    1. Liberman M, Cassivi SD. Bronchial stump dehiscence: Update on prevention and management. Semin Thorac Cardiovasc Surg. 2007;19:366–373.
    1. Shen KR. Management of acquired nonmalignant tracheoesophageal fistula: Surgical pearls. J Thorac Cardiovasc Surg. 2017;154:e123.
    1. Shen KR, Allen MS, Cassivi SD, et al. Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae. Ann Thorac Surg. 2010;90:914–918; discussion 919\.
    1. Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM. Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula. Ann Transl Med. 2018;6:210.
    1. Algar FJ, Alvarez A, Aranda JL, Salvatierra A, Baamonde C, López-Pujol FJ. Prediction of early bronchopleural fistula after pneumonectomy: A multivariate analysis. Ann Thorac Surg. 2001;72:1662–1667.

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