Intrathoracic muscle flap transposition: an original surgical technique

Bronchopleural fistula (BPF) and pleural empyema are severe and still challenging complication of lung cancer surgery. Many treatments are described in the literature to face these problems, such as open window thoracostomy (OWT) and thoraco-myoplasty. These procedures often require demolitive surgery and long hospitalization. We present a case of a 70-year-old male patient who experienced residual pleural cavity's empyema and BPF after open thoracotomy right lower lobectomy. In order to control infection and attempt to close the fistula, our patient underwent negative-pressure wound therapy (NPWT) through an OWT. The treatment proved to be useful in resolve infection and narrowing the pleural cavity, but wasn't enough in sealing the fistula. After months of dressings, we decided to perform myoplasty using a pedicled muscle flap from ipsilateral rectus abdominis, that was transposed through the OWT and anchored with an original technique, due to preoperative computed tomography (CT)-guidewire positioning. While common intrathoracic muscle flap transposition's techniques involve reopening the chest and do not provide a way to anchor it, the technique herein described proved to be effective in firmly fixing the pedicle in the right position, avoiding a redo thoracotomy. Uncomplicated postoperative course was observed and the patient was discharged home after 17 days, without chest drain and antibiotics. Therefore, this technique is suitable for treating BPF and pleural empyema.