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. 2025 Feb 5;40(2):ivaf012.
doi: 10.1093/icvts/ivaf012.

Long-term retention of the pedicled thymic flap after bronchial stump coverage

Takahiro Karasaki  1 , Sakashi Fujimori  1 , Souichiro Suzuki  1 , Shinichiro Kikunaga  1 , Kazuki Ito  1 , Yosuke Hamada  1 , Shusei Mihara  1
Affiliations

Long-term retention of the pedicled thymic flap after bronchial stump coverage

Takahiro Karasaki et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

This study aimed to assess the feasibility and retention rates of pedicled thymic flaps to enhance understanding of bronchial stump coverage. A retrospective analysis of 22 consecutive patients who underwent anatomical lung resection followed by bronchial stump coverage with pedicled thymic flaps between January 2017 and December 2022 was conducted. The procedure was performed using a minimally invasive three-port video-assisted thoracoscopic surgery technique for all patients with no complications related to graft harvest or fixation. Postoperative retention of the engrafted flaps was evaluated in the 16 patients who underwent thin-slice computed tomography at least once after surgery. The majority of the postoperative computed tomography examinations were performed for surveillance of lung cancer recurrence. The retention rates of pedicled thymic flaps were 100% at 60 days, 87% at 180 days and 70% at 1 year post-surgery. Pedicled thymic flaps can be safely harvested using a minimally invasive approach, and the majority of engrafted flaps remain adjacent to the bronchial stump for more than 1 year. This technique may be a viable option for patients at high risk of a delayed bronchopulmonary fistula.

Keywords: complications; minimally invasive surgery; video-assisted thoracoscopic surgery.

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Figures

Figure 1:
Figure 1:
Retention rate of the pedicled thymic flaps after surgery. (A, B) Postoperative CT scans showing the retention of the flap adjacent to the bronchial stump (arrowheads) at postoperative days 35 (A) and 413 (B). (C) Swimmer plot showing days of the CT scan. A circle (o) represents the day of the CT scan with a retained flap, and a cross (×) represents the day of the earliest CT scan with a regressed flap. Solid lines represent the periods with a high probability of having a retained flap, and dotted lines represent the period during which the flap has possibly regressed. (D) Bar plot showing the proportion of the retained and regressed flaps at each time point after surgery
See this image and copyright information in PMC

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