Gazi Md. Zakir Hossain1, Kazi Saiful Islam2, Anwarul Anam Kibria2, A K M Razzaque3,Shafiqul Ahsan4, Golam Mohiuddin Akbar Chowdhury5, Zillur Rahman6
Abstract:
Objectives: The study was done to find out the effectiveness of intercostal
muscle flap in reducing the postoperative bronchopleural fistula (BPF).
Method: This prospective clinical study was conducted in NIDCH during the
period of July 2006 to June 2008. According to inclusion criteria seventy (70)
patients were selected who underwent pneumonectomy. They were divided
into two groups. Group A (Case) having their bronchial stump covered by an
intercostal muscle flap and group B (Control) having their bronchial stump
uncovered. A number of pre-operative and post operative variables were
recorded including complications and death. All patients were followed up
for three months at one month interval.
Result: In this study the mean age of the subjects was 31.4 ± 14.4 years. Among
the patients 44(63%) were male and 26(37%) were female. 5 (7.1%) patients
were clinically diagnosed as having neoplastic lung diseases, 28 (40%) of the
patients exhibited PTB with destroyed lung, 17 (24.3%) had bronchiectasis
with destroyed lung, 12 (17.2%) patients suffered from empyema thoracis with
trapped lung, and 8 (11.4%) had other lung diseases. Comparison of
postoperative morbidities illustrates that mechanical ventilation, reopening
for bleeding, stump infection, stump leakage and wound infection all were
homogeneously distributed between groups (p > 0.05). A significantly less
post-operative hospital stay was observed in the case group than that in the
control group (15.4 ± 6.2 vs. 20.0 ± 8.4 days, p = 0.011). Association between
ICM flap reinforcement and development of BPF shows that incidence of
bronchopleural fistula was significantly less in the case group i.e. 1 patient
(3%) compared to their control counterpart i.e. 5 patients (14.7%) (p = 0.015).
Conclusion: It can be concluded from our study that buttressing the bronchial
stump after pneumonectomy by intercostal muscle flap is a safe operation
which effectively reduces the rate of post-pneumonectomy BPF.
Key Words: BPF, Bronchial stump, Intercostal Muscle Flap