The Bedi-IMA Buttress

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The development of a bronchopleural fistula (BPF) is a devastating complication that can occur after lung resection. Currently, a number of techniques are described, but each has its own limitations. The authors describe an innovative new method to address this problem by buttressing the closure of the stump using a pedicled internal mammary artery (IMA) flap. 

Methods 

A total of 18 patients underwent the procedure (four pneumonectomies and 14 lobectomies). A standard postero-lateral thoracotomy was performed, followed by the lung resection. The IMA was then harvested using standard techniques. The IMA flap was brought down and sewn over the bronchus in a cap-like fashion using interrupted 4-0 Prolene sutures so that the whole bronchial stump was covered. Primary outcomes of interest were the development of BPF and empyema. Follow-up consisted of a mean of 16 ± 9.2 months (range was 7 to 24 months). 

Results  

The flap of viable vascularized muscle mass was easily harvested and provided excellent coverage of the bronchial stump. All patients recovered well with no bronchopleural fistulas. 

Conclusions 

This technique is an additional and innovative strategy for avoiding a broncho pleural fistula. The authors recommend this technique as a method of buttressing the bronchial stump in cases of lung resection, as the internal mammary artery is easily available, and its use is not associated with any immediate side effects. 

References

1. Sfyridis PG, Kapetanakis EI, Baltayiannis NE, Bolanos NV, Anagnostopoulos DS, Markogiannakis A, et al . Bronchial Stump Buttressing With an Intercostal Muscle Flap in Diabetic Patients. Ann Thorac Surg 2007;84:967–72.
2. Anderson TM, Miller Jr JI. Use of pleura, azygos vein, pericardium, and muscle flaps in tracheobronchial surgery [Review]. Ann Thorac Surg 1995;60:729–33
3. D'Andrilli A, Ibrahim M , Andreetti C Ciccone AM , Venuta F , Rendina EA . Transdiaphragmatic Harvesting of the Omentum Through Thoracotomy for Bronchial Stump Reinforcement . Ann Thorac Surg 2009;88:212-215

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