Prophylactic Bronchial Stump Support with Intrathoracic Muscle Flap Transposition

Malke Asaad, Amelia Van Handel, Arya A. Akhavan, Tony C.T. Huang, Aashish Rajesh, K. Robert Shen, Mark A. Allen, Basel Sharaf, Steven L. Moran

Research output: Contribution to journalArticlepeer-review


Background Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage. Methods A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. Results A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%). Conclusions Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.

Original languageEnglish (US)
Pages (from-to)317-322
Number of pages6
JournalAnnals of plastic surgery
Issue number3
StatePublished - Mar 1 2021


  • bronchial support
  • flap
  • muscle
  • plastic
  • reconstruction
  • thoracic

ASJC Scopus subject areas

  • Surgery


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