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ROUTINE USE OF PEDICLED LATISSIMUS DORSI MUSCLE FALP IN HIGH RISK THORACIC SURGERY PROCEDURES

UCI Medical Center, Orange, CA

PURPOSE: Postoperative empyema and bronchopleural fistulas (BPF) are dreaded complications following thoracic surgical procedures. Use of a muscle flap to eliminate space problems and provide bronchial stump coverage has been previously reported in selected circumstances. We reviewed our experience with routine use of a pedicled latissimus dorsi muscle as our preferred flap in high risk thoracic surgery procedures.

METHODS: Over a two year period (2003 - 2005), nine patients (age range 24-74) with a myriad of complex intrathoracic diseases underwent harvesting of the ipsilateral latissimus dorsi muscle based on its thoracodorsal neurovascular pedicle just prior to performing a thoracotomy. Seven patients were immunocompromised; three receiving systemic steroids; two status-post chemotherapy; and two HIV(+). Five patients had severe underlying pulmonary disease with mean FEV1 42% of predicted.

RESULTS: Three upper lobectomies and one completion left pneumonectomy were performed for massive hemoptysis secondary to complex aspergilloma. One patient underwent left pneumonectomy for ruptured cavitary primary lung lymphoma.One upper lobectomy was done for necrotizing localized Mycobacterium avium-intracellulare. One patient underwent right upper lobectomy and main stem bronchoplasty for carcinoma after induction chemoradiation therapy. In two patients, the muscle flap was used to buttress closure of a chronic BPF. There were no operative deaths. There were no postoperative empyemas. Two patients developed contained bronchial stump leaks requiring no further surgical intervention.

CONCLUSION: Transposed pedicled latissimus dorsi muscle flap is an effective and reliable method in prevention of empyema and clinically overt BPF. We advocate its routine use in first time and selected redo thoracotomies in patients undergoing high risk lung resection or reparative procedures.

CLINICAL IMPLICATIONS: Routine sparing and transposition of a vascularized latissimus dorsi muscle flap, if available, can circumvent some of the major postoperative complications following complex and high risk thoracic surgical procedures.

DISCLOSURE: Amir Abolhoda, None.