Background: The use of diaphragmatic pedicle flaps for reconstructive procedures in thoracic surgery is not very popular. Nevertheless, it provides considerable advantages. Methods: Our experience covers 10 years (1987-1997) with a total of 25 patients in whom the diaphragmatic flap was used for different purposes. In 6 patients we used the diaphragmatic flap to protect the bronchopleural fistula at its early onset, which was not beyond 12 hours from the clinical diagnosis. We performed prophylactic suture protection after neoadjuvant therapy in 9 high-risk patients who underwent pneumonectomy and in 2 who underwent sleeve lobectomy. Postpneumonectomy pericardial defect repair was performed in 4 patients. In another 4 patients the diaphragmatic flap was used after spontaneous (n = 2) and iatrogenic (n = 2) lesions of the esophagus after 24 to 72 hours. Results: No perioperative mortality was recorded. Complications were mainly related to the severe preoperative conditions of the patients: arrhythmia, respiratory insufficiency, and empyema. We report only 2 cases of minimal persistent bleeding from the chest tube, which spontaneously ceased. For those patients who survived for more than 1 year (n = 11), no diaphragmatic hernias were recorded. Bronchopleural fistulas and pericardial defects healed in all instances. The diaphragmatic flap was also effective in bronchopleural fistula. A late fistula caused by cancer relapse at the bronchial stump developed in only one patient. Excellent repair was achieved in all patients with esophageal lesions. Conclusions: We conclude that the diaphragmatic flap can be considered a practical, safe, and redundant material particularly indicated for defect or fistula closure and for suture line protection in the thoracic cavity.

Mineo, T.c., Ambrogi, V. (1999). The diaphragmatic flap: A multiuse material in thoracic surgery. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 118(6), 1084-1089.

The diaphragmatic flap: A multiuse material in thoracic surgery

MINEO, TOMMASO CLAUDIO;AMBROGI, VINCENZO
1999-01-01

Abstract

Background: The use of diaphragmatic pedicle flaps for reconstructive procedures in thoracic surgery is not very popular. Nevertheless, it provides considerable advantages. Methods: Our experience covers 10 years (1987-1997) with a total of 25 patients in whom the diaphragmatic flap was used for different purposes. In 6 patients we used the diaphragmatic flap to protect the bronchopleural fistula at its early onset, which was not beyond 12 hours from the clinical diagnosis. We performed prophylactic suture protection after neoadjuvant therapy in 9 high-risk patients who underwent pneumonectomy and in 2 who underwent sleeve lobectomy. Postpneumonectomy pericardial defect repair was performed in 4 patients. In another 4 patients the diaphragmatic flap was used after spontaneous (n = 2) and iatrogenic (n = 2) lesions of the esophagus after 24 to 72 hours. Results: No perioperative mortality was recorded. Complications were mainly related to the severe preoperative conditions of the patients: arrhythmia, respiratory insufficiency, and empyema. We report only 2 cases of minimal persistent bleeding from the chest tube, which spontaneously ceased. For those patients who survived for more than 1 year (n = 11), no diaphragmatic hernias were recorded. Bronchopleural fistulas and pericardial defects healed in all instances. The diaphragmatic flap was also effective in bronchopleural fistula. A late fistula caused by cancer relapse at the bronchial stump developed in only one patient. Excellent repair was achieved in all patients with esophageal lesions. Conclusions: We conclude that the diaphragmatic flap can be considered a practical, safe, and redundant material particularly indicated for defect or fistula closure and for suture line protection in the thoracic cavity.
1999
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/21 - CHIRURGIA TORACICA
English
Con Impact Factor ISI
adjuvant therapy; adult; aged; article; bronchopleural fistula; clinical article; diaphragm hernia; diaphragm muscle; esophagus muscle; female; heart protection; human; lung resection; male; muscle flap; priority journal; surgical technique; suturing method; thorax surgery; wound healing; Adult; Aged; Arrhythmia; Bronchial Fistula; Chest Tubes; Diaphragm; Empyema; Esophageal Diseases; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Intraoperative Complications; Male; Middle Aged; Neoadjuvant Therapy; Pericardium; Pleural Diseases; Pneumonectomy; Postoperative Hemorrhage; Respiratory Insufficiency; Respiratory Tract Fistula; Risk Factors; Surgical Flaps; Survival Rate; Suture Techniques; Thoracic Surgical Procedures
Mineo, T.c., Ambrogi, V. (1999). The diaphragmatic flap: A multiuse material in thoracic surgery. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 118(6), 1084-1089.
Mineo, Tc; Ambrogi, V
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/50053
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