Management of a complicated pulmonary fistula caused by lung cancer using a fibrin glue-soaked polyglycolic acid sheet covered with an intercostal muscle flap.

Pulmonary fistulas caused by tumours are very fragile and difficult to suture directly. It is impossible to close pulmonary fistulas with tissue sealants when massive air leakage occurs in the low pressure of the respiratory tract. A 73-year-old man with a pneumothorax caused by lung cancer had suffered a persistent massive air leakage for more than one month. We used a fibrin glue-soaked polyglycolic acid (PGA) sheet for sealing the complicated fistula. In addition, the visceral pleura of the fistula was wrapped with the pedicle of an intercostal muscle (ICM) flap to prevent massive air leakage. The pneumothorax did not reappear after surgery. Thus, a fibrin glue-soaked PGA sheet covered with an ICM flap was effective for sealing an intractable air-leaking fistula caused by lung cancer.

[1]  R. Cerfolio,et al.  A nondivided intercostal muscle flap further reduces pain of thoracotomy: a prospective randomized trial. , 2008, The Annals of thoracic surgery.

[2]  Y. Izumi,et al.  The short-term efficacy of fibrin glue combined with absorptive sheet material in visceral pleural defect repair. , 2006, Interactive cardiovascular and thoracic surgery.

[3]  Yukihito Saito,et al.  Bronchial stump reinforcement with the intercostal muscle flap without adverse effects. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  Yukihito Saito,et al.  Intercostal muscle flap without increase of pain and blood loss after lung surgery. , 2006, The Journal of thoracic and cardiovascular surgery.

[5]  R. Cerfolio,et al.  Intercostal muscle flap reduces the pain of thoracotomy: a prospective randomized trial. , 2005, The Journal of thoracic and cardiovascular surgery.

[6]  A. Patchefsky,et al.  Case report 3 , 1976, Skeletal Radiology.

[7]  Zumin Wang,et al.  Fibrin glue and bioabsorbable felt patch for intraoperative intractable air leaks. , 2003, The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi.

[8]  P. Wurnig,et al.  Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle flap. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  Y. Shimizu,et al.  [Clinical experience of the combined use of polyglycolide non-woven felt with fibrin glue to prevent postoperative pulmonary fistula]. , 1995, [Zasshi] [Journal]. Nihon Kyobu Geka Gakkai.

[10]  Y. Shimizu,et al.  New bioabsorbable pledgets and non-woven fabrics made from polyglycolide (PGA) for pulmonary surgery: clinical experience. , 1990, The Thoracic and cardiovascular surgeon.