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Ann Thorac Surg 2001;71:2082-2083
© 2001 The Society of Thoracic Surgeons

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Correspondence

Diaphragm flap for routine prophylactic reinforcement of bronchial stump after pneumonectomy: Reply

^a Department of Thoracic Surgery, Tor Vergata University Rome, Ospedale S. Eugenio, 10 Piazzale Umanesimo, 00144 Rome, Italy

e-mail: mineo{at}med.uniroma2.it

To the Editor

We appreciate the interest expressed by Drs Sayeed-Shah, Strachan, and Elefteriades, in our article on the early treatment of bronchopleural fistula using a pedicled diaphragmatic flap [1]. As we described, use of diaphragmatic pedicle flaps for reconstructive procedures in thoracic surgery is safe and practical [2].

Since 1987, we have performed a total of 27 procedures in which the diaphragm was employed for protective or reconstructive purposes for early bronchopleural fistula (n = 6); prophylaxis of pneumonectomy stumps (n = 10) and bronchial anastomoses (n = 2); pericardial defect (n = 4); and early spontaneous (n = 2) and iatrogenic (n = 3) esophageal lesions.

No perioperative mortality was recorded. Complications were mainly related to the poor preoperative condition of the patients. For those patients who survived more than 1 year (n = 13), no diaphragmatic hernias occurred. Bronchopleural fistulas, esophageal fistulas, and pericardial defects healed in all instances. The diaphragmatic flap was also effective in preventing bronchopleural fistula; only one patient developed a late fistula due to cancer relapse at the bronchial stump.

Contrary to Drs Sayeed-Shah, Strachan, and Elefteriades, we do not perform a stump protection flap on a routine basis, but use it in patients who have neoadjuvant therapy, vascular disease, or diabetes. We do not contest their strategy; the diaphragmatic flap is ready available after a pneumonectomy and it is the ideal material for preventing bronchopleural fistula, which is a dreadful, life-threatening complication.

To conclude, we are pleased about the renewed interest elicited by our article. Indeed, this flap is an ace up the sleeve, and solves many dangerous situations. Again, we congratulate Drs Sayeed-Shah, Strachan, and Elefteriades for the point they raise for the routine use of the diaphragmatic flap following pneumonectomy.

References

1. Mineo T.C., Ambrogi V. Early closure of the postpneumonectomy bronchopleural fistula by pedicled diaphragmatic flaps. Ann Thorac Surg 1995;60:714-715.[Abstract/Free Full Text]
2. Mineo T.C., Ambrogi V. The diaphragmatic flap: a multiuse material in thoracic surgery. J Thorac Cardiovasc Surg 1999;118:1084-1089.[Abstract/Free Full Text]

This Article Full Text (PDF) 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tommaso C. Mineo Vincenzo Ambrogi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mineo, T. C. Articles by Ambrogi, V. Search for Related Content PubMed Articles by Mineo, T. C. Articles by Ambrogi, V. Related Collections Lung - other Related Article