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Ann Thorac Surg 1996;61:1876-1877
© 1996 The Society of Thoracic Surgeons

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Correspondence

Pleural Slide Technique for Covering the Left Bronchial Stump

The Cardiothoracic Centre Thomas Dr Liverpool L14 3PE, Uk

To the Editor:

Anderson and Miller [1] have recently described a technique for pleural flap harvesting when covering the bronchial stump at left pneumonectomy. The hinge of the flap often lies along the line of incision of the posterior mediastinal pleura. This sometimes makes the flap's attachment to extrapleural fascia rather tenuous. The pleural flap is also at risk of damage during extrapleural dissection. We would like to describe an alternative technique of pleural slide rather than pleural flap for this situation.

A curved, 10-cm incision is made in the parietal pleura overlying the outer third of the aortic arch (Fig 1). Five or six vertical mattress sutures of 3/0 Ethibond (Ethicon, Somerville, NJ) are placed through the anterior and posterior cut edges of the mediastinal pleura. The sutures are passed posterior to the vagus nerve so that this structure is not included in the pleural suture line. The sutures are then tied to bring the edges of pleura together loosely (Fig 2). It is not necessary to dissect the pleura off the aorta because it slides easily on its fascia.

View larger version (33K): [in this window] [in a new window]   Fig 1. . Left hilum at the completion of pneumonectomy showing the bronchial stump and the line of incision along the aorta (dotted line). Vertical mattress sutures have been placed along the cut edges of the mediastinal pleura.

View larger version (34K): [in this window] [in a new window]   Fig 2. . Left hilum after the mattress sutures have been tied. The arrow indicates the pleural slide, which leaves a bare area over the aorta (shaded).

Reference

1. Anderson TM, Miller JI Jr. Use of pleura, azygos vein, pericardium, and muscle flaps in tracheobronchial surgery. Ann Thorac Surg 1995;60:729–33.[Abstract/Free Full Text]

Reply

Department of Cardiothoracic Surgery The Emory Clinic 25 Prescott St, NE Suite 3420 Atlanta, Ga 30308

To the Editor:

Doctors Berrisford and Mercer have presented an additional method of covering the left main bronchial stump. It should be remembered that the left main stump generally does not need to be covered because of its location up under the aorta. It is only in cases of radiation, infection, or compromised blood supply that the left stump would be covered.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard G. Berrisford Joseph I. Miller, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Berrisford, R. G. Articles by Miller, J. I. Search for Related Content PubMed PubMed Citation Articles by Berrisford, R. G. Articles by Miller, J. I., Jr