Hanaoka Takaomi, Nakajima Yutsuki, Shiraishi Yuji, Katsuragi Naoya, Konno Hidehiro
Department of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 2004 Feb;52(2):84-7. doi: 10.1007/s11748-004-0091-2.
The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because of empyema with Pseudomonas aeruginosa Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after a standard posterolateral incision.
一名51岁男性在因肺曲霉菌病行左上肺叶切除及胸廓成形术后并发脓胸及支气管胸膜瘘（BPF）。术后第12天，开放的支气管残端直接缝合，并用带蒂胸大肌瓣覆盖。术后第66天，因铜绿假单胞菌感染导致的脓胸行开窗胸廓造口术。两年后，我们通过转移改良带蒂肌皮瓣并附加胸廓成形术填充脓胸腔，闭合多个支气管胸膜瘘，使患者获得了良好的生活质量。尽管肌皮瓣是背阔肌的近端部分，是沿着首次手术的后外侧切口进行解剖的，但它能够成功移植以覆盖开窗处的支气管胸膜瘘。对于一些前胸壁上部开窗较小的患者，即使经过标准的后外侧切口，带蒂近端背阔肌肌皮瓣对于治疗持续性支气管胸膜瘘可能也非常有用。
