Background:Peripheral bronchopleural fistula (BPF) and empyema from necrotising infections of the lung and pleural is difficult to treat resulting in increased morbidity and mortality rates. The aim of this study was to show the effectiveness of the Latissimus Dorsi muscle (LDM) flap and patch closure techniques in the management of recalcitrant peripheral BPFs with the aid of thoracotomy.Materials and Methods:Five patients with BPF and empyema out of 26 patients who were initially treated for empyema thoracis by single or multiple chest tube insertions and/or ultrasound-guided drainage were prospectively identified and followed up for 2 years, postoperatively. The postoperative hospital stay, dyspnoea score, function of the ipsilateral upper limb and any deformity of chest wall were assessed at follow-up visits by asking relevant questions.Results:The mean age was 46.8 years (23-69 years) (4 males and 1 female). The cause of the BPF in 18 patients was Mycobacterium tuberculosis and 8 was pneumonia. The mean total months of the chest tube insertions was 1.5 months (range 2.5-6 months) prior to the thoracotomy and closure of fistula procedures performed on the 5 patients (with LDM flap in 4 patients and pleural patch in 1 patient). The complications recorded were: subcutaneous emphysema, residual pus and haemothorax in three patients. The mean postoperative hospital stay was 20.8 days (13-28 days);There was improved dyspnoea score to 1 or 2 in the 5 (19.2%) patients. There was no recurrence of BPF or residual pus in all the patients; no loss of function or deformity of the chest wall.Conclusion:The use of LDM Flap was effective in treating peripheral BFP without any adverse long-term outcome.

The brachial artery is the commonest artery injured in the extremities. Although the patients present late, nevertheless reconstructions is advocated in other to salvage the limb and maintain function of the hand. We retrospectively examined 25 consecutive patients with vascular injuries treated at The Cardiovascular and Thoracic Surgery Unit of a tertiary health centre over a period of 4 years. We assessed the pre-tertiary methods of stopping of bleeding injured brachial arteries, mechanisms of injury, associated injuries, treatment and the outcome following vascular repair in terms of functionality of the forearm and the volume of the radial pulsation. A total of 12 patients (48.0%) had brachial artery injuries out of the 25 patients with different forms of vascular injuries during the period. There were 10 males and 2 females, aged 7.5-65 years. The aetiology of the brachial artery injuries were: Glass cut in 5 patients, knife cut in 3 patients, surgical complication of tendon release (iatrogenic) in 1 patient, injury from self injection of pentazocine in 1 patient, machete cut in 1 patient and blunt vascular injury from fan belt injury in 1 patient. Except for the young girl whose brachial artery was injured at surgery, and had lateral repair done within 3hours, the timing between injury and repair in the remaining 11 patients ranged between 6-288 hours. This was beyond the golden time in trauma cases. Two patients had the brachial artery revascularised using the Reversed Saphenous Vein Graft (RSVG). The wrist pulsation was small volume in one patient as felt by palpation before discharge though the forearm was viable. Otherwise the remaining patients’ outcome was good. Most of the patients with brachial artery injury present late following injury. Revascularisation beyond the golden hour is still desirable as it will help to prevent limb loss. Plans should be put in place to train vascular surgeon to encourage prompt and expertise care.

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