Intercostal muscle pedicle flap for prophylaxis against bronchopleural fistula after pulmonary resection

Between April 1982 and March 1994, we did 384 pulmonary resections for lung cancer. Until March 1991, we did 249 pulmonary resections in which none of the bronchial stumps were reinforced; nine patients developed bronchopleural fistula (incidence, 4%). After April 1991, bronchial stumps of 135 patients were reinforced by an intercostal muscle pedicle flap for prophylaxis against bronchopleural fistula. Only one patient developed it (incidence, 1%). In these two periods, the proportion of patients in stage IIIa or more advanced stages increased from 24% to 41%, resulting in more extensive operations and more patients being given chemo-radiation therapy in the perioperative period. These are risk factors for bronchopleural fistula, but the incidence of the fistula decreased. These results suggest that reinforcement of the bronchial stump with an intercostal pedicle flap is useful for prophylaxis against developing bronchopleural fistula.