Thoracomyoplasty and perioperative negative wound pressure therapy for bronchopleural fistula after trans-sternal bronchial closure

Abstract

A 62-year-old male complained of recurrent hemoptysis from a right-side pulmonary fungal ball (Figure 1). His right main pulmonary artery was accidentally sacrificed during a bilobectomy 10 years ago, and the remnant lung had a cavitary lesion. We performed trans-sternal transpericardial bronchial closure to avoid pneumonectomy through the infected thoracic cavity and to control the patient's bloody cough [1]. The bronchial stump was closed using a surgical stapler and reinforced with Prolene sutures with felt pledgets. There were no postoperative complications, and the patient was discharged on postoperative day 13. Two months later, a bronchopleural fistula developed at the bronchial stump (Figure 2). The patient had undergone video-assisted thoracosopic surgery irrigation and complete pneumonectomy (Figure 3) [2-4], and then dead spaces were obliterated via a thoracomyoplasty procedure and perioperative negative pressure wound therapy (Figure 4) [5]. The last outpatient follow-up was 1 year later. The wound remained clean, and the patient's performance level was not impaired relative to his preoperative state. In the absence of standardized protocols for managing such patients, our reported case offers a review of these classic procedures that hybridize a minimally invasive technique with a tailored approach for each individual. This study was approved by the Institutional Review Board of the Korea University Ansan Hospital (IRB No. AS2021-0278) and written informed consent was waived. © 2021 The Korean Society of Critical Care Medicine.