Current Treatment of Bronchopleural-Cutaneous Fistula
Cameron Stock, Nicole B. Cherng, Karl F. Uy, Geoffrey Graeber, University of Massachusetts Medical School, Worcester, MA
OBJECTIVE: To review our management of bronchopleural-cutaneous fistula (BPF) following pulmonary resection.
METHODS: A case-series was performed at a tertiary medical center of patients who developed a BPF following pulmonary resection from 2013-2015. Anatomy and operative techniques were analyzed. Outcome measures included successful BPF closure and mortality.
RESULTS: Three patients met criteria. Two cases developed a bronchial stump leak following right pneumonectomy for lung adenocarcinoma. The third patient developed a BPF following left lower lobectomy for pulmonary sequestration. In all cases, after performing an Eloesser window to allow the infected pleural space to drain, we closed the fistula by direct suture repair of the bronchus combined with pedicled muscle flap reinforcement. Once we confirmed closure of the fistula by resolution of the air leak and bronchoscopic examination, either a secondary Clagett procedure or negative pressure wound therapy (NPWT) was used to close the Eloesser flap and residual infected thoracic cavity. In the post-pneumonectomy patients, serratus anterior muscle flaps were used to cover the stump followed by a secondary Clagget procedure. For the BPF following a lobectomy, both serratus anterior and intercostal muscle flaps were used to provide complete coverage of the bronchial stump. The residual pleural cavity was smaller and therefore closed with NPWT. All cases had successful closure without mortality.
CONCLUSIONS: Closure of a BPF requires direct repair of the bronchus followed by muscle flap reinforcement. Closure of the remaining cavity is successful when no infection is present, the air leak is completely abolished, and adequate nutrition is maintained.