Management of osteomyelitis and a bronchopleurocutaneous fistula after coronary artery bypass grafting
Abstract
Report an unusual case of development of bronchopleurocutaneous fistula after AKB surgery. Five years ago the patient had a rightsided upper lobectomy because of lung adenocarcinoma (stadiumT1N0M0).
Following the heart surgery there was an exacerbation of chronic obstructive bronchopulmonary disease and dehiscence of sternotomy suture and osteomyelitis of the sternum occurred as a consequence of persistent cough. After a local sanation of inflammation re-suture of sternum was necessary however the healing was not successful.
Therefore we used the V. A.
C. system. Air bubbles were noted in the area of the sternotomy scar.
Our suspicion of a communication with airways was proved by fistulography, which showed bronchial tree of the 2nd segment of the left upper lobe. The only possible solution was an ablation of the afflicted lung segment which was a source of permanent infection using anatomical resection and excision of the fistula.
Haemostasis out of bleeding mammary artery we used TachoSil.