Insufficient expansion of the residual lung after pulmonary resection is considered a serious complication, particularly in cases of surgically treated infectious pulmonary disease. After the operation, the dead spaces were shown to be filled with transposed omental flap by both postoperative chest X-ray and chest CT examination ( Figure 3). Several sutures were used to fix the omental flap to the adjacent tissue, and two drainage catheters were placed. The omental flap was passed through the substernal route and placed in the dead space of the left upper lung field. Blunt dissection for formation of a substernal route to the left upper lung field was done, along with massive irrigation with sterile saline. As the volume of omental tissues was deemed sufficient for a flap, a 7 cm mid-line laparotomy was performed, producing a pedicled omentum ( Figure 2). After general anesthesia, we assessed the volume of the omental tissue using a laparoscope. To prepare for the omental flap, we performed an esophagogastroduodenoscopy to screen for occult upper gastrointestinal malignancies, with no significant findings.

We decided to use an omental flap, rather a muscle flap, in consideration of the patient’s muscle volume, as he exhibited a low body mass index (BMI 16.8 kg/m 2), as well as other sarcopenic features. After discharge, chest CT scans taken in an out-patient clinic showed no significant change in dead space volume in the left upper lung field, and the turbid chest tube drainage persisted. We recommended that the patient undergo an eloesser flap or thoracoplasty however, he refused and was discharged 21 days postoperatively with a Heimlich bag.

The infection was irrigated with betadine solutions for 2 weeks, though the infection was not cleared. A postoperative chest X-ray revealed a dead space in the left upper lung field, potentially due to an incomplete expansion of the left lower lobe.īy day 8, the drainage fluid had changed from clear to turbid, identified by in vitro culture as Pseudomonas aeruginosa. Based on these findings, we performed a left upper lobectomy with left lower lobe superior segmentectomy. A dense adhesion was detected in the whole lung field, and the major fissure of the left lung was absent, characterized by a consolidation of left upper lobe, which extended to the superior segment of the left lower lobe. A fungal ball with cicatrization atelectasis can be seen in the left upper lobe.Īfter general anesthesia, we performed a serratus-sparing posterolateral thoracotomy at the fifth intercostal space. Preoperative chest computed tomography (CT) scan.

Dead space lung