{"title":"Usefulness of free subcutaneous fat pads for refractory secondary pneumothorax due to lung cancer.","authors":"Shunichi Saito, Mikihiro Kohno, Shinkichi Takamori, Naoko Miura, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.1510/mmcts.2023.085","DOIUrl":null,"url":null,"abstract":"<p><p>Surgical treatment for a pneumothorax involves resection of the pulmonary pleural fistula, and closure of the fistula or coverage of the fistula using pericardial fat pads or an intercostal muscle flap. In some cases, however, these treatments are difficult because of thickened pleura or dense pleural adhesions in the thoracic cavity. We report two cases of refractory secondary pneumothorax due to lung cancer that were successfully treated using free subcutaneous fat pads to cover the pulmonary pleural fistulas. Both patients had advanced lung cancer, and each developed a pneumothorax after chemotherapy or the administration of osimertinib. Each had a prolonged air leak despite chest tube drainage. We harvested a free subcutaneous fat pad around the thoracotomy site and sutured it to cover the fistula. After the operation, the air leak disappeared immediately, and the chest tube was removed from each patient on postoperative day 2. Computed tomography at 2 or 4 months postoperatively demonstrated that the free subcutaneous fat pads were still present with no sign of pneumothorax. Application of free subcutaneous fat pads to cover a persistent pulmonary pleural fistula is useful for the treatment of secondary pneumothorax due to lung cancer.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1510/mmcts.2023.085","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
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Abstract
Surgical treatment for a pneumothorax involves resection of the pulmonary pleural fistula, and closure of the fistula or coverage of the fistula using pericardial fat pads or an intercostal muscle flap. In some cases, however, these treatments are difficult because of thickened pleura or dense pleural adhesions in the thoracic cavity. We report two cases of refractory secondary pneumothorax due to lung cancer that were successfully treated using free subcutaneous fat pads to cover the pulmonary pleural fistulas. Both patients had advanced lung cancer, and each developed a pneumothorax after chemotherapy or the administration of osimertinib. Each had a prolonged air leak despite chest tube drainage. We harvested a free subcutaneous fat pad around the thoracotomy site and sutured it to cover the fistula. After the operation, the air leak disappeared immediately, and the chest tube was removed from each patient on postoperative day 2. Computed tomography at 2 or 4 months postoperatively demonstrated that the free subcutaneous fat pads were still present with no sign of pneumothorax. Application of free subcutaneous fat pads to cover a persistent pulmonary pleural fistula is useful for the treatment of secondary pneumothorax due to lung cancer.
期刊介绍：
The Multimedia Manual of Cardio-Thoracic Surgery (MMCTS) is produced by The European Association for Cardio-Thoracic Surgery (EACTS). MMCTS is the world’s premier video-based educational resource for cardiovascular and thoracic surgeons; freely accessible - and essential - for all. MMCTS was launched more than ten years ago under the leadership of founding editor Professor Marko Turina. It was Professor Turina’s vision that the European Association for Cardio-Thoracic Surgery (EACTS), already the world-leader in CT surgery education, should take advantage of the Internet’s rapidly improving video publication capabilities and create a new step-by-step manual of surgical procedures. Professor Turina and EACTS agreed that the manual, MMCTS, should be freely accessible to all users, regardless of association membership status, nationality, or affiliation. MMCTS was self-published by EACTS for some years before being transferred to Oxford University Press, which hosted it until the end of 2016. In November 2016, the Manual returned home to EACTS and it has now relaunched in a completely new format. Since its birth in 2005, MMCTS has published some 400 detailed, video-based demonstrations of cardio-thoracic surgical procedures. Tutorials published prior to 2012 have been archived and we are working with the authors of these tutorials to update their work pending republication on the new site. Our mission is to make MMCTS the best online reference for cardio-thoracic surgeons – residents and experienced surgeons alike. Our aim is to include tutorials presenting procedures at both a fundamental and an advanced level. Truly innovative procedures are also included and are identified as such.
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