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Intercostal muscle flap to protect the bronchial stump in pediatric lobectomy for lung abscess
Insights
This study introduces the intercostal muscle (ICM) flap technique for pediatric lung surgery, aiming to prevent broncho-pleural fistula after lobectomy in children with suppurative lung disease.
Area of Science:
- Pediatric Thoracic Surgery
- Surgical Innovation
- Pulmonary Medicine
Background:
- Lung abscesses in children typically respond to medical or percutaneous treatment.
- Pulmonary resection, specifically lobectomy, is rarely needed for pediatric lung abscesses, often due to comorbidities.
- Broncho-pleural fistula is a significant complication following pediatric lobectomy, occurring in up to 9.1% of cases, potentially due to inflammation or surgeon inexperience.
Purpose of the Study:
- To report the first pediatric application of the intercostal muscle (ICM) flap technique.
- To evaluate the feasibility of using ICM flaps to protect the bronchial stump after lobectomy in children.
- To assess the potential of ICM flaps in preventing broncho-pleural fistula in pediatric thoracic surgery.
Main Methods:
- The study involved 2 immunocompetent children who underwent lobectomy for suppurative lung conditions.
- An intercostal muscle (ICM) flap was utilized to buttress the bronchial stump following lobectomy.
- This technique, previously established in adult lung cancer surgery, was adapted for pediatric use.
Main Results:
- The application of the ICM flap in both pediatric patients was technically feasible.
- The preliminary experience suggests the ICM flap can effectively protect the bronchial stump after pediatric lobectomy.
- This approach shows promise in mitigating the risk of broncho-pleural fistula development in pediatric thoracic procedures.
Conclusions:
- The intercostal muscle (ICM) flap is a viable technique for bronchial stump protection in pediatric lobectomy.
- This method is particularly beneficial for children with suppurative lung conditions at high risk for broncho-pleural fistula.
- Further research is warranted to confirm the long-term efficacy and benefits of ICM flaps in pediatric thoracic surgery.
Abstract:
Lung suppurative diseases in children are usually responsive to medical treatment or percutaneous drainage. Rarely, pulmonary resection is required for lung abscess in childhood, particularly in presence of co-morbidities. In these cases, a lobectomy is usually performed through an open thoracotomy, with a reported incidence of bronco-pleural fistula up to 9.1% of pediatric series. This consequence is mainly due to the inflammatory condition; however the lack of knowledge of pediatric and thoracic surgeons with this rare condition in childhood can also play a role. In adults with lung cancer, the buttressing of bronchial stump with the additional support of an intercostal muscle (ICM) flap has proved to prevent this complication, as well as to reduce post-operative pain. We report the first pediatric experience of ICM flap used in 2 immunocompetent children requiring lobectomy for suppurative lung conditions. Our preliminary experience confirms the feasibility of protecting the bronchial stump after lobectomy in children, especially in conditions at risk for bronco-pleural fistula development.
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