PMC9634460_01
OCW defect prior to VRAM free flap reconstruction. OCW, open Clagett window; VRAM, vertical rectus abdominis myocutaneous.
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The patient underwent daily dressing changes and antibiotic therapy for three months until the pleural cavity was without evidence of infection and white blood cell counts normalized (Figure 1).
CT imaging of BPF defect 3 weeks before and 2 weeks after VRAM free flap repair. (A) Cross-sectional CT image 3 weeks before repair. (B) Axial CT image 3 weeks before repair. (C) Cross-sectional CT image 2 weeks after repair. (D) Axial CT image 2 weeks after repair. BPF, bronchopleural fistula; VRAM, vertical rectus abdominis myocutaneous.
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The patient's only remarkable complication was a persistent subcutaneous emphysema which was confirmed on CT imaging (Figure 2), whereby a right pigtail pleural chest tube was placed on POD 13 remained in place for 39 days until his subcutaneous emphysema completely resolved.
VRAM free flap repair incisions 3 months post-operatively. VRAM, vertical rectus abdominis myocutaneous.
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Additionally, he has resumed adjuvant chemotherapy for definitive treatment of his marginal zone lymphoma after recovering successfully from his VRAM free flap reconstruction (Figure 3).