28422883 Visualization

A 61 Age - year Age - old Age male Sex patient had a history of chronic History obstructive History pulmonary History disease History under regular History bronchodilator History treatment History .
In 2014 Date , he suffered from severe Severity productive Detailed_description cough Sign_symptom with mucus Detailed_description sputum Detailed_description for Duration several Duration months Duration and unintentional Detailed_description body weight Sign_symptom loss Sign_symptom 6 Lab_value   kg Lab_value within Duration 6 Duration months Duration .
After sputum Diagnostic_procedure analysis Diagnostic_procedure and chest Biological_structure imaging Diagnostic_procedure examinations Diagnostic_procedure in May Date 2014 Date , he was diagnosed of squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder in right Biological_structure upper Biological_structure lobe Biological_structure lung Biological_structure ( cT3N2M0 Lab_value , stage Lab_value IIIa Lab_value ).
Then he received neoadjuvant Detailed_description chemoradiotherapy Therapeutic_procedure ( etoposide Medication 70 Dosage   mg Dosage [45 Dosage   mg/m2] Dosage  +  cisplatin Medication 79 Dosage   mg Dosage [50 Dosage   mg/m2] Dosage ; 4500 Dosage   cGY Dosage in Dosage 25 Dosage fractions Dosage ) from Duration June Duration to Duration July Duration 2014 Duration .
In October Date 2014 Date , surgical Therapeutic_procedure intervention Therapeutic_procedure was arranged.
Because the tumor Sign_symptom was located at right Biological_structure hilum Biological_structure and invaded main Biological_structure bronchus Biological_structure and major Biological_structure vessels Biological_structure , video Detailed_description - assisted Detailed_description thoracoscopic Detailed_description surgery Therapeutic_procedure with right Detailed_description side Detailed_description intrapericardial Biological_structure pneumonectomy Therapeutic_procedure was performed.
Postoperatively, pathological Diagnostic_procedure exams Diagnostic_procedure revealed squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder , T3N0M0 Lab_value , stage Lab_value IIB Lab_value .
The postoperative Therapeutic_procedure course Therapeutic_procedure was smooth Lab_value but he suffered from severe Severity cough Sign_symptom and right Biological_structure chest Biological_structure pain Sign_symptom one Date month Date later Date .
Laboratory Diagnostic_procedure exams Diagnostic_procedure revealed leukocytosis Sign_symptom ( white Diagnostic_procedure blood Diagnostic_procedure cells Diagnostic_procedure  =  21,860 Lab_value   μL Lab_value ) and elevated Lab_value C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure to 23.94 Lab_value  mg/dL.
Chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure showed cavitary Detailed_description lesion Sign_symptom and computed Diagnostic_procedure tomography Diagnostic_procedure showed pleural Sign_symptom effusion Sign_symptom and fluid Sign_symptom collection Sign_symptom with mottled Detailed_description gas Detailed_description appearance Detailed_description in the dependent Biological_structure portion Biological_structure of Biological_structure right Biological_structure hemithorax Biological_structure (Fig.1A).
According to the patient's history, results of laboratory exams, and imaging findings, postpneumonectomy Detailed_description empyema Sign_symptom was diagnosed and bronchopleural Disease_disorder fistula Disease_disorder was highly suspected.
After admission Clinical_event , chest Biological_structure tube Therapeutic_procedure drainage Therapeutic_procedure was inserted and bronchoscopic Detailed_description tissue Therapeutic_procedure glue Therapeutic_procedure sealing Therapeutic_procedure was performed.
However, persistent Detailed_description air Sign_symptom leakage Sign_symptom was presented and we decided to repair Therapeutic_procedure the bronchial Biological_structure stump Biological_structure with flap Therapeutic_procedure coverage Therapeutic_procedure .
Because the patient just received neoadjuvant Detailed_description chemoradiotherapy Therapeutic_procedure a few months ago, the flaps harvested from chest area were not appropriate because the pedicle arteries might have been injured by irradiation.
After discussing with the plastic surgeon, we decided to repair Therapeutic_procedure the bronchial Biological_structure stump Biological_structure by a TRAM Therapeutic_procedure flap Therapeutic_procedure .
Intraoperatively, the patient was placed Therapeutic_procedure in Therapeutic_procedure supine Therapeutic_procedure .
Right Detailed_description side Detailed_description exploratory Detailed_description thoracotomy Diagnostic_procedure was performed and the bronchial Biological_structure stump Biological_structure was located.
The superior Biological_structure epigastric Biological_structure vascular Biological_structure artery Biological_structure and right Biological_structure rectus Biological_structure abdominis Biological_structure muscle Biological_structure was identified and the location of the TRAM Therapeutic_procedure flap Therapeutic_procedure was marked Detailed_description on Detailed_description the Detailed_description skin Detailed_description (Fig.2A).
Then the TRAM Therapeutic_procedure flap Therapeutic_procedure was harvested Therapeutic_procedure from right Biological_structure rectus Biological_structure abdominis Biological_structure (Fig.2B) and was deepithelialized Therapeutic_procedure (Fig.2C).
Through a subcutaneous Therapeutic_procedure tunnel Therapeutic_procedure , the TRAM Therapeutic_procedure flap Therapeutic_procedure was moved toward the right Biological_structure thoracic Biological_structure space Biological_structure with no tension Sign_symptom or kinking Sign_symptom on the pedicle Biological_structure (Fig.2D).
Then the TRAM Therapeutic_procedure flap Therapeutic_procedure was fixed to posterior Biological_structure chest Biological_structure wall Biological_structure to cover the bronchial Biological_structure stump Biological_structure (Fig.2E) and the tissue Therapeutic_procedure glue Therapeutic_procedure was also applied to the bronchial Biological_structure stump Biological_structure under bronchoscope Diagnostic_procedure .
The donor Biological_structure site Biological_structure of Biological_structure flap Biological_structure was closed with mesh Therapeutic_procedure repair Therapeutic_procedure .
The postoperative Therapeutic_procedure course Therapeutic_procedure was smooth Lab_value and the air Sign_symptom leak Sign_symptom was diminished Lab_value gradually.
Then the patient was discharge Clinical_event under stable Sign_symptom condition Sign_symptom and was free from air Sign_symptom leak Sign_symptom after Date following Date for Date 12 Date months Date (Fig.1B).
The patient provided written informed consent for publication of this report and all accompanying images.