Pneumonectomy with coverage of bronchial stump - 1259743

tvoltagg
Posts:30

I have heard from a number of folks who have had total lung pneumonectomies. My wife had one a year ago and still needs regular pain meds. I see many stories here where folks seem to have recovered much better than my wife ay least with regards to need for pain meds. I'm curious if it is because of the latissimus flap procedure wherein the lattissmus dorsi muscle is cut vertically and half is pulled over to cover the bronchial stump. This necessitates the removal of a rib or two (1-1/2 in my wife's case).

So I'm curious if this is the procedure that most folks get with their pneumonectomies or whether this is unusual. That might explain the difference in recovery.

Any help among the pneumonectomy "group" would be helpful. Thank you.

Tom

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Reply # - October 8, 2013, 06:08 PM

Dr West
Posts: 4735

I'll see if I can get input from a thoracic surgery colleague about that. I would say that a bigger surgery, especially one in which ribs are removed, poses a bigger risk for chronic pain issues, but it's still a crap shoot. I have a handful of patients over the years who have had significant pain problems long after surgery, and it's definitely just a small minority, but I haven't detected any real pattern among them of what might lead to it. My sense is it's more random than anything else, but I'll see if any of the thoracic surgeons knows anything about a higher risk of pain issues from the latissimus dorsi flap procedure.

-Dr. West

Reply # - October 11, 2013, 03:21 PM

drfarivar
Posts: 5

there is no specific reason a lat flap would cause more pain, but the ribs being removed may have caused more irritation of the nerves which would lead to pain. I generally wouldnt use a lat flap initially for a standard pneumonectomy unless I was particularly worried about the healing of the stump of the airway, in which case I do think it is a good idea. I agree with Dr West's comments above as well

Reply # - October 12, 2013, 05:14 PM

tvoltagg
Posts: 30

Thank you Dr, West and Farivar. I never did understand that the flap was a "choice". It's possible that the surgeon here in Philadelphia was concerned about the fact that the tumor inside the lung became infected pre-surgery and my wife was in the hospital for week with a fever, continuous coughing, not sleeping and not eating as they tried to combat the infection with antibiotics to no avail. They did not to operate while she had the infection, but after the week of no progress in combating the infection, the decision was made to go in and take the lung out, thus ridding the body of the infection and the tumor. Since she was T4N0M0 at the time, it seemed like the right decision. Perhaps operating with an infection in the lung was a factor for the flap.

Tom

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