1
|
David CH, D'Journo XB, Dutau H, Thomas PA. Transdiaphragmatic plombage omentoplasty without thoracotomy for post-lobectomy bronchial fistula. J Thorac Cardiovasc Surg 2019; 157:e413-e415. [PMID: 30857821 DOI: 10.1016/j.jtcvs.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Charles-Henri David
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University & Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier B D'Journo
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University & Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Pascal A Thomas
- Department of Thoracic Surgery, North Hospital, Aix-Marseille University & Assistance Publique-Hôpitaux de Marseille, Marseille, France; Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, Aix-Marseille University, Marseille, France.
| |
Collapse
|
2
|
|
3
|
Abstract
Ischemia is the primary risk factor for airway complications in double lung transplantation using tracheal anastomosis and in tracheal transplantation. Many treatment options as to revascularization for the trachea were herein described and reviewed. They include direct revascularization (using a conduit such as artery or vein), revascularization with tissue wrapping (using omentum, muscle, internal thoracic artery pedicle, pleura, or pericardial fat pad), and with drug administration (using corticosteroid hormone, prostaglandin, or angiogenic factor). As there are few organized reports including new information on revascularization for the trachea these days, this review article would help thoracic surgeons who get engaged transplantation.
Collapse
Affiliation(s)
- Ryoichi Nakanishi
- Department of Thoracic Surgery, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Kokurakita-ku, Kitakyushu, Japan.
| |
Collapse
|
4
|
Misaki N, Yamamoto Y, Okamoto T, Chang SS, Igai H, Gotoh M, Tabata Y, Yokomise H. Intra-thoracic fibrous tissue induction by polylactic acid and epsilon-caprolactone copolymer cubes, with or without slow release of basic fibroblast growth factor. Eur J Cardiothorac Surg 2007; 32:761-5. [PMID: 17766134 DOI: 10.1016/j.ejcts.2007.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 06/29/2007] [Accepted: 07/13/2007] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We investigated whether implantation of polylactic acid and epsilon-caprolactone copolymer (PLAC) cubes with or without basic fibroblast growth factor (b-FGF) released slowly from gelatin microspheres was able to induce fibrous tissue in the dead space remaining after pneumonectomy in the thoracic cavity. METHODS Left pneumonectomy was performed in Japanese white rabbits. In the control group (n=6), the left thoracic cavity was closed without any treatment. In the FGF group (n=6), gelatin microspheres that released 100 microg of b-FGF were implanted into the left thoracic cavity. In the PLAC group (n=6), PLAC cubes were implanted into the left thoracic cavity. In the PLAC/FGF group (n=6), both PLAC cubes and gelatin microspheres releasing 100 microg of b-FGF were implanted into the left thoracic cavity. RESULTS In the control and FGF groups, herniation of the heart, mediastinal shift, and overinflation of the right lung were observed. No granular tissue formation was observed. In the PLAC and PLAC/FGF groups, a dense area of newly formed soft tissue was observed, and only a mild mediastinal shift was observed during the 3-month follow-up period. Pathological examination revealed induction of fibrous and granular tissue in the left thoracic cavity. The foreign-body reaction induced by PLAC was very mild. CONCLUSIONS Implantation of PLAC cubes with or without gelatin microspheres releasing 100 microg of b-FGF is able to induce fibrous tissue in the post-pneumonectomy dead space.
Collapse
Affiliation(s)
- Noriyuki Misaki
- Second Department of Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Uchida T, Wada M, Sakamoto J, Arai Y. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case. Surg Today 1999; 29:186-9. [PMID: 10030748 DOI: 10.1007/bf02482248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (Picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.
Collapse
Affiliation(s)
- T Uchida
- Department of Surgery, Aichi Prefectural Hospital, Okazaki, Japan
| | | | | | | |
Collapse
|
6
|
Nakanishi R, Hashimoto M, Yasumoto K. Improved airway healing using basic fibroblast growth factor in a canine tracheal autotransplantation model. Ann Surg 1998; 227:446-54. [PMID: 9527069 PMCID: PMC1191284 DOI: 10.1097/00000658-199803000-00018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We studied 22 dogs to examine the effect of basic fibroblast growth factor (bFGF) alone, in comparison with omental or muscular wrapping on airway healing in a tracheal autotransplantation model. SUMMARY BACKGROUND DATA Basic fibroblast growth factor is one of the most potent promoters of angiogenesis and has an ability to enhance blood supply to the ischemic airway. Topical administration of a fibrin glue enriched with 5 microg/cm2 bFGF, determined as a proportion of surface area of the tracheal grafts, improved revascularization of orthotopic canine tracheal autografts in a previous study. METHODS All animals received orthotopic tracheal transplantation using 6-ring autografts that occupied a distal part of the thoracic trachea. Twenty-two animals were classified randomly into the following four groups: no treatment (Group G1, n = 4), muscular wrapping (Group G2, n = 4), omental wrapping (Group G3, n = 4), and topical administration of fibrin glue enriched with 5 microg/cm2 bFGF (Group G4, n = 10). Autografts were harvested 60 days after transplantation and assessed by the percent patency and histology. RESULTS Devascularized tracheal autografts could not maintain their structural integrity without other treatments (Group G1). In contrast, more than half of all autografts receiving treatments remained viable, as demonstrated by gross and histologic findings (Groups G2, G3, and G4). Treatments with bFGF and omentum showed significantly better graft viability than no treatment. However, there was no statistical difference in the viability of tracheal autografts among the three treatment groups. In terms of the time performance ratio, bFGF was the best treatment for the devascularized autografts. CONCLUSIONS Topical administration of bFGF was superior to the omental or muscular wrapping in terms of the time performance ratio. Clinical trials will be necessary to determine whether these findings are applicable to humans.
Collapse
Affiliation(s)
- R Nakanishi
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | |
Collapse
|
7
|
Puskas JD, Mathisen DJ, Grillo HC, Wain JC, Wright CD, Moncure AC. Treatment strategies for bronchopleural fistula. J Thorac Cardiovasc Surg 1995; 109:989-95; discussion 995-6. [PMID: 7739261 DOI: 10.1016/s0022-5223(95)70325-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Successful management of chronic postoperative bronchopleural fistula remains a challenge for thoracic surgeons. Forty-two patients (33 referred from other institutions) were treated for major postoperative bronchopleural fistula since 1978. Factors associated with bronchopleural fistula included right pneumonectomy (n = 23), left pneumonectomy (n = 8), long bronchial stump (n = 16), pneumonia (n = 13), radiation therapy (n = 12), stapled bronchial closure (n = 8), prolonged mechanical ventilation (n = 7), recurrent carcinoma (n = 6), and tuberculosis (n = 2). Patients had undergone an average of 3.3 surgical procedures to correct their bronchopleural fistulas during a mean interval of 24 months before our treatment. Bronchopleural fistulas were located in the right main bronchial stump (n = 23), left main bronchial stump (n = 8), right lobar bronchial stumps (n = 10), and tracheobronchial anastomosis (n = 1). Thirty-five patients were treated by suture closure of the bronchial stump, buttressed with vascularized pedicle flaps of omentum (n = 19), muscle (n = 13), or pleura (n = 2). In seven cases, direct suture closure was not possible, and omental (n = 6) or muscle (n = 1) flaps were sutured over the bronchopleural fistula. Suture closure without pedicle coverage was performed successfully in one case. Initial repair of the fistula was successful in 23 of 25 patients treated with omentum, in nine of 14 patients treated with muscle and in neither of two patients treated with pleural flaps. In nine patients with persistent or recurrent bronchopleural fistula after our initial repair, four underwent a second procedure (three successful) and five were managed with drainage only. The fistula was successfully closed in 11 of 12 patients who had received high-dose radiation therapy (nine with omentum). Overall, successful closure of bronchopleural fistula was achieved in 36 of 42 patients (86%). Four in-hospital deaths resulted from pneumonia and sepsis, two in patients with recurrent bronchopleural fistula after pleural flap closure. In 16 patients the empyema cavity was obliterated during definitive repair of the fistula. The cavity resolved with drainage in four others, nine had draining cavities at follow-up, and one was lost to follow-up. Ten patients required a total of 17 Clagett procedures and one had a delayed myoplasty. Direct surgical repair of chronic bronchopleural fistula may be achieved in most patients after adequate pleural drainage by suture closure and aggressive transposition of vascularized pedicle flaps. Omentum is particularly effective in buttressing the closure of bronchopleural fistulas.
Collapse
Affiliation(s)
- J D Puskas
- Thoracic Surgical Service, Massachusetts General Hospital, Boston 02114, USA
| | | | | | | | | | | |
Collapse
|
8
|
Huang CL, Kitano M, Shindo T, Nagasawa M. Systemic artery-to-pulmonary artery shunt after using an omental pedicle flap. Ann Thorac Surg 1995; 59:993-5. [PMID: 7695430 DOI: 10.1016/0003-4975(94)00703-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 66-year-old man was hospitalized because of hemoptysis. Four years earlier, he had undergone an operation involving the use of an omental pedicle flap that was supplied by the right gastroepiploic artery for the treatment of empyema. Arteriography revealed that the right gastroepiploic artery communicated with the periphery of the right pulmonary artery. The right gastroepiploic artery was divided surgically.
Collapse
Affiliation(s)
- C L Huang
- Department of Thoracic Surgery, Tenri Hospital, Nara, Japan
| | | | | | | |
Collapse
|
9
|
Tsubota N, Murotani A, Yoshimura M, Miyamoto Y, Maniwa Y. Treatment of tuberculous empyema with multiple fistulae by reexpansion of the affected lung and restoration of its function: report of a case. Surg Today 1994; 24:663-5. [PMID: 7949781 DOI: 10.1007/bf01833738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report herein the case of a patient in whom a calcified tuberculous empyema with multiple fistulae was successfully treated by a new surgical approach. Reexpansion of the affected lung which had calcified over 30 years was achieved by covering the multiple bronchial fistulae using the omentum without obliterating the empyema cavity. Although the patient presented with severe aspiration pneumonia, he made a complete recovery and is now leading a better quality of life than before. This new operative method is less invasive and can therefore be performed much more easily on critically ill patients than conventional methods.
Collapse
|
10
|
Abstract
An effective method of vascularization is required in tracheal transplantation, as tracheal vessels are too find to be anastomosed easily. A series of experiments, including postmortem injection study, were conducted to assess the usefulness of omentopexy for tracheal autografts in 17 dogs. In group I (n = 4) a six-ring tracheal autograft was implanted in the greater omentum for 28 days. The structural integrity of all the autografts was maintained. In group II (n = 3) a six-ring cervical trachea was excised and reimplanted as an autograft without omental wrapping. All three autografts dissolved or transformed. No neovascularity from the recipient trachea or surrounding tissue was seen in the autografts by postoperative day 11. In group III (n = 10) omentopexy was added to the same experiment as group II. All the autografts were nourished adequately by the omental circulation as demonstrated by injection study, and remained viable early after transplantation. We conclude that the omentopexy is an effective method to facilitate neovascularization in tracheal autografts.
Collapse
Affiliation(s)
- R Nakanishi
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | |
Collapse
|
11
|
Kamei Y, Moriura S, Ikeda S, Hosokawa H, Hirai M, Naiki K, Yoshitomo K, Kato J, Torii S. Combination gastric seromuscular patch and omental pedicle flap for bronchial fistula. Ann Thorac Surg 1993; 56:366-8. [PMID: 8347024 DOI: 10.1016/0003-4975(93)91179-q] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report the successful closure of a recurrent bronchial fistula using a combination gastric seromuscular patch and omental pedicle flap. This new method provided an immediate airtight closure of the bronchial fistula. This technique appears superior to closure by omentum alone.
Collapse
Affiliation(s)
- Y Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University of School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Current techniques of management of carinal lesions are not always satisfactory. Carinal transplantation, if feasible, would be valuable in certain circumstances. METHODS AND RESULTS Carinal transplantation experiments were performed in dogs. In early cross transplant experiments there were problems in controlling ventilation and in obtaining satisfactory anastomoses, and the animals failed to live for even a few days. In seven subsequent experiments the carinal graft was removed from one dog and transplanted into a second dog. Two dogs lived for over four months with immunosuppression. CONCLUSION The results suggest that carinal transplantation can succeed if (1) the calibre of the graft is matched with that of the recipient; (2) there is an abundant blood supply to the graft; (3) appropriate immunosuppression is provided; (4) ventilation is adequate during surgery.
Collapse
Affiliation(s)
- H Ueda
- Second Department of Surgery, School of Medicine, Fukuoka University, Japan
| | | |
Collapse
|
13
|
Fujino S, Inoue S, Yamashita N, Mori A. An experimental study on direct revascularization of bronchial circulation by microvascular anastomosis. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34693-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Mayer E, Cardoso PF, Puskas JD, Campos KD, Oka T, Dardick I, Patterson G. The effect of basic fibroblast growth factor and omentopexy on revascularization and epithelial regeneration of heterotopic rat tracheal isografts. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34851-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
15
|
Ueda H, Shibata K, Kusano T. Postoperative pyothorax. Surg Today 1992; 22:115-9. [PMID: 1498489 DOI: 10.1007/bf00311334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Twenty-five cases of pyothorax occurred in a series of 1281 thoracotomies. Almost all cases of pyothorax without bronchopleural fistula were successfully treated by closed drainage and irrigation alone. On the other hand, patients with pyothorax and fistula who were treated only with closed drainage almost all had a poor outcome. When pyothorax with fistula was treated by closed drainage and irrigation followed by further procedures such as open window thoracostomy, muscle plombage and/or omentopexy, treatment was successful. It is concluded that pyothorax without fistula may be cured by closed drainage and irrigation alone, but that pyothorax with fistula requires operative intervention such as open window thoracostomy or omental flap as soon as possible.
Collapse
Affiliation(s)
- H Ueda
- Second Department of Surgery, School of Medicine, Fukuoka University, Japan
| | | | | |
Collapse
|
16
|
Tsubota N, Hatta T, Yoshimura M, Yanagawa M. A case of empyema developing thirteen years after a pneumonectomy treated using pedicled omentum which was followed by intestinal obstruction. THE JAPANESE JOURNAL OF SURGERY 1991; 21:703-5. [PMID: 1787621 DOI: 10.1007/bf02471060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Postpneumonectomy empyema is one of the most difficult complications for the thoracic surgeon to treat. We report herein a case of a 62 year old diabetic man who developed empyema 13 years after a pneumonectomy for cancer, which was successfully treated using an omental pedicle flap. Postoperatively, the chest would healed uneventfully, however, a bowel obstruction developed which was subsequently treated by removing the remnant omentum that had adhered to the bowel.
Collapse
Affiliation(s)
- N Tsubota
- Department of Thoracic Surgery, Hyogo Medical Center, Japan
| | | | | | | |
Collapse
|
17
|
Olech VM, Keshavjee SH, Chamberlain DW, Slutsky AS, Patterson GA. Role of basic fibroblast growth factor in revascularization of rabbit tracheal autografts. Ann Thorac Surg 1991; 52:258-64. [PMID: 1713756 DOI: 10.1016/0003-4975(91)91348-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite omentopexy of the bronchial anastomosis, donor airway ischemia remains a problem after lung transplantation. This study examined the hypothesis that surface abrasion and topical application of basic fibroblast growth factor (bFGF) would enhance omental revascularization of trachea in a rabbit heterotopic autograft model. Tracheal segments were excised, primary tracheal anastomoses performed, and the segments placed in the peritoneal cavity wrapped in omentum. Animals were randomized to one of six groups according to tracheal segment treatment: control, surgical abrasion, Surgicel wrap with topical bFGF, Surgicel wrap with bFGF vehicle, Gelfoam wrap with bFGF, and topical bFGF alone. One week later, animals were heparinized, perfused with Aquablak dye, and killed. Tracheal segments were excised and sectioned for light microscopic quantitative assessment of viability and dye perfusion. There was no significant improvement in viability or perfusion between abraded tracheal segments or segments treated with bFGF/Gelfoam or bFGF alone when compared with control segments. Airways wrapped in Surgicel had significantly greater ischemic injury compared with the control group, regardless of bFGF application. Neither surgical abrasion nor topical bFGF increased omental revascularization of transplanted tracheal segments after 7 days.
Collapse
Affiliation(s)
- V M Olech
- Department of Surgery, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
18
|
Raul Herrera H, Geary J, Whitehead P, Evangelisti S. Revascularization of the Lower Extremity with Omentum. Clin Plast Surg 1991. [DOI: 10.1016/s0094-1298(20)30847-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
19
|
Omental pedicle flap for the management of postoperative bronchopleural fistulae. Indian J Thorac Cardiovasc Surg 1991. [DOI: 10.1007/bf02667127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
20
|
Shirakusa T, Ueda H, Takata S, Yoneda S, Inutsuka K, Hirota N, Okazaki M. Use of pedicled omental flap in treatment of empyema. Ann Thorac Surg 1990; 50:420-4. [PMID: 2400263 DOI: 10.1016/0003-4975(90)90487-q] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Omental pedicle flaps were used in the treatment of patients with acute and chronic empyema with bronchopleural fistula. In 5 patients (group 1) with postoperative acute empyema owing to bronchial stump fistula, an omental covering was applied as a reinforcement to close the fistula. Six patients in group 2 with chronic tuberculous or Aspergillus empyema with multiple fistulas initially underwent open-window thoracostomy or cavernostomy and secondarily had omental transposition. In all patients, the right gastroepiploic vessels were used to provide the blood supply for the flap. Successful closure of the bronchial stump was obtained in all patients in group 1, but 2 of them died of recurrence of their underlying lung carcinoma within 1 year. Five of the 7 patients in group 2 had a favorable outcome, but 2 patients had partial recurrence after omental plombage. From our experience with these patients, we believe that the omental flap is effective for closing fistulas due to postoperative or chronic empyema but has only limited success in patients whose lungs are severely damaged by persistent infection.
Collapse
Affiliation(s)
- T Shirakusa
- Second Department of Surgery, School of Medicine, Fukuoka University, Japan
| | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Abstract
The supply of donor organs remains extremely limited, and improved methods of maintaining the lungs of potential donors to allow for transplantation must be developed. Currently the upper limit of donor lung ischemic even with our "best" preservation techniques is approximately 4 to 6 hours. Improved methods for preservation will increase the supply of suitable lungs and will considerably simplify the logistics of transplantation just as has occurred with liver transplantation. Efficient use of donor organs remains of paramount importance. We recently performed two single-lung transplants utilizing lungs from one donor. Likewise, there is no reason why a lung could not be sent to another center for transplantation if the harvesting group uses only one lung. Sufficient progress has been achieved to date to warrant continued application of lung transplantation for end-stage pulmonary disease. With increasing experience, one can anticipate refinement of techniques and broader application of these procedures. Single lung transplantation, initially restricted to patients with end-stage pulmonary fibrosis, has now been successfully applied to patients with emphysema, pulmonary hypertension, and other conditions. Although transplantation currently can offer real benefit only to a limited number of persons, it serves to create hope for many others. An additional benefit may prove to be the interest and attention that transplantation focuses on patients with end-stage lung disease and on the pathophysiology of chronic respiratory failure. Knowledge gained may ultimately result in the prevention of many of the disorders for which lung transplantation currently offers the only hope.
Collapse
Affiliation(s)
- T M Egan
- Department of Surgery, University of North Carolina, Chapel Hill School of Medicine
| | | | | |
Collapse
|
23
|
Varela A, López L, Monzón R, Torre W, Manzano J. Complicaciones infecciosas toracicas tratadas con mioplastias y omentoplastias. Arch Bronconeumol 1989. [DOI: 10.1016/s0300-2896(15)31701-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
Asaoka M, Imaizumi M, Kajita M, Uchida T, Niimi T, Abe T. One stage repair for an oesophageal fistula after pneumonectomy using an omental pedicle flap. Thorax 1988; 43:943-4. [PMID: 3222770 PMCID: PMC461575 DOI: 10.1136/thx.43.11.943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 67 year old man developed an oesophageal fistula after a pneumonectomy that was complicated by an empyema. An omental pedicle flap was brought through the diaphragm to repair the fistula and to fill the empyema space. The outcome was successful.
Collapse
Affiliation(s)
- M Asaoka
- Department of Thoracic Surgery, Nagoya University School of Medicine, Japan
| | | | | | | | | | | |
Collapse
|
25
|
Mathisen DJ, Grillo HC, Vlahakes GJ, Daggett WM. The omentum in the management of complicated cardiothoracic problems. J Thorac Cardiovasc Surg 1988. [DOI: 10.1016/s0022-5223(19)35736-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
Kaplan DK, Andrew J, Thorpe C. Use of an omental pedicle graft to repair a large oesophageal defect. Thorax 1988; 43:333-4. [PMID: 3406922 PMCID: PMC461225 DOI: 10.1136/thx.43.4.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
27
|
|
28
|
Williams R, White H. The greater omentum: its applicability to cancer surgery and cancer therapy. Curr Probl Surg 1986; 23:789-865. [PMID: 3780294 DOI: 10.1016/0011-3840(86)90007-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
29
|
|
30
|
Carbajo Carbajo M, Ortega Morales F, Hernandez Alonso M, Torre Buxaleu W. Abordaje transesternal de fistula postneumonectomia. A proposito de dos casos. Arch Bronconeumol 1985. [DOI: 10.1016/s0300-2896(15)32185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Morgan E, Lima O, Goldberg M, Ayabe H, Ferdman A, Cooper J. Improved bronchial healing in canine left lung reimplantation using omental pedicle wrap. J Thorac Cardiovasc Surg 1983. [DOI: 10.1016/s0022-5223(19)38911-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
32
|
Successful revascularization of totally ischemic bronchial autografts with omental pedicle flaps in dogs. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)39034-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
33
|
Lima O, Goldberg M, Peters W, Ayabe H, Townsend E, Cooper J. Bronchial omentopexy in canine lung transplantation. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)37278-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Perianayagam WJ, Booshanam MV, Muralidharan S, Jairaj PS, John S. The use of an omental pedicle flap in the closure of bronchopleural fistulae. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1980; 50:204-6. [PMID: 6930243 DOI: 10.1111/j.1445-2197.1980.tb06670.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Two recurrent bronchopleural fistulae in patients in whom previous intercostal myoplasty had failed were successfully closed by an omental pedicle flap and a bucket-handle flap slide over the omentum. The original procedure in both was left lower lobectomy. The advantages of the procedure are its simplicity, the absence of cosmetic defect, and its suitability for left lower or lingular bronchopleural fistulae when other procedures have failed.
Collapse
|
35
|
|
36
|
Virkkula L, Eerola S, Appelqvist P. Repair of stricture and fistula of the antethoracic oesophagogastrostoma using a reversed pectoralis skin pedicle flap. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1977; 11:67-9. [PMID: 322271 DOI: 10.3109/14017437709167816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A 68-year-old male patient with oesophageal cancer was treated by oesophageal resection and the antethoracic reconstruction was made by using the ventricle. The oesophagogastrostoma developed a necrosis and later a 5 cm stricture and a gastrocutaneous fistula. Both the stricture and the fistula were treated by plastic surgery using a reversed pectoralis skin pedicle flap and free skin graft.
Collapse
|