Bronchopleural fistula repair using combined breast parenchymal and pectoralis major musculocutaneous flap

A technique is reported for repair of a bronchopleural fistula and obliteration of an empyema cavity using a combined breast parenchymal and expanded, musculocutaneous pectoralis major flap. An empyema after right upper lobectomy and radiation for squamous cell carcinoma developed in a 53-year-old woman. After debridement, a bronchopleural fistula was noted. Her latissimus dorsi muscle was divided during the initial thoracotomy. Local and free flaps were considered. Her breast contained the largest volume of tissue available as she weighed 80 pounds. This report illustrates the use of a tissue-expanded, combined breast and musculocutaneous pectoralis flap in the management of a difficult problem.