Pedicled Latissimus Dorsi Muscle Flap in Thoracic Surgery
Montien Ngodngamthaweesuk MD*, Chanawit Sitthisombat MD**
Affiliation : * Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Division of Cardiothoracic Surgery, Department of Surgery, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
Background : Bronchopleural fistula and empyema are serious complications after thoracic surgery and their prevention is
very important. The use of transposed extrathoracic muscle flaps to cover bronchial stumps and to eliminate dead space is a
good management technique.
Objective : Evaluate the efficacy and safety of a pedicled latissimus dorsi (PLD) muscle flap in high-risk thoracic surgery.
Material and Method: This retrospective study was performed between July 2008 and December 2013 in 17 patients who
underwent PLD muscle flap and decortication or bullectomy. These patients were divided into three groups from their
diseases. The first group (empyema) was eleven patients (7 men, 16- to 78-year-old). The second group (spontaneous
pneumothorax, bullae, and COPD) was five patients (5 men, 42- to 81-year-old), and the third group (malignant pleural
effusion) was one patient (woman, 57-year-old).
Results : In the first group (empyema), there were three postoperative death from eleven patients (27.27%) (two with septic
shock from pneumonia with lung cancer stage IV and pulmonary tuberculosis and one with congestive heart failure with
severe aortic stenosis) after decortication and PLD muscle flap. Additionally, six patients required packed red blood cells,
about 270 mL per patient and eight patients needed intensive care unit (ICU) for 1 to 9 days (mean = 2.38 days). Mean length
of hospital stay was 13.27 days (7 to 40 days). In the second group (spontaneous pneumothorax, bullae and COPD) there
were no morbidity and mortality after bullectomy, pleurectomy, and PLD muscle flap. Two patients needed ICU for a day. In
the third group (malignant pleural effusion from breast cancer), there was one postoperative death (100%) from sudden
cardiac arrest after decortication and PLD muscle flap.
Conclusion : The use of pedicled latissimus dorsi muscle flap is effective and safe in high-risk thoracic surgery for the
obliteration of chronically infected pleural space and prevention of bronchopleural fistula.
Keywords : Pedicled latissimus dorsi (PLD) muscle flap, Bronchopleural fistula, Empyema
