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Ann Thorac Surg 2005;80:1017-1020
© 2005 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Birmingham, Alabama
b Department of Epidemiology, School of Public Health, Birmingham, Alabama
c Department of Cardiovascular and Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
Accepted for publication March 21, 2005.
* Address reprint requests to Dr Cerfolio, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd, THT 712, Birmingham, AL 35294 (Email: robert.cerfolio{at}ccc.uab.edu).
Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
BACKGROUND: We assessed our outcomes using an intercostal muscle flap harvested with cautery prior to chest retraction.
METHODS: Our retrospective study was conducted using an electronic prospective database.
RESULTS: There were 456 patients (348 men) over a six year period. The intercostal muscle flap was used for bronchial coverage in 391 patients. The indications for the flap were neoadjuvant radiochemotherapy in 285 patients, infection or inflammatory disease in 106, to buttress an esophageal-gastric anastomosis in 49, and for esophageal fistula in 16. There were three bronchopleural fistulas (0.7%); one after a right pneumonectomy for tuberculosis, one after a left pneumonectomy, and one after a lobectomy in a heart transplant patient for mucormycosis. The 4-week median postoperative pain score for patients who underwent an intercostal muscle flap was lower compared with historic controls who underwent similar procedures over the same time frame but did not have an intercostal muscle flap (2.4 vs 3.7, p = 0.003). Follow-up was a median of 26 months (range, 1 to 72 months) and no patients had ossification of their flap.
CONCLUSIONS: An intercostal muscle flap is a versatile pedicle flap that can reach all bronchi. It is easy to harvest, adds no morbidity, and may protect the bronchi at risk. When harvested devoid of periosteum it does not ossify over time and it may reduce the pain of thoracotomy.
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