Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.
Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Gastric Fistula ; Humans ; Intercostal Muscles

Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block.
Glottis ; Hiccup* ; Humans ; Intercostal Muscles ; Nerve Block ; Phrenic Nerve*

The management of chronic empyema remains still disturbing. These patients always have chances to exposure septic conditions. We presents 4 patients of chronic empyema with sepsis who underwent E-flap and Myoplasty with extrathoracic skeletal muscles between December 1994 and March 1997. Two patients who had BPF were treated with intercostal muscle flap as co-procedures. Intervals between first E-flap and second Myoplasty ranged from 5 to 10 months. There was no morbidity or mortality. We think these stepwise procedure offers a chance to terminate these debilitating disease.
Empyema* ; Humans ; Intercostal Muscles ; Mortality ; Muscle, Skeletal ; Sepsis*

We report our experience with 2 cases of perforation of intrathoracic stomach after Ivor Lewis operation for esophageal cancer. There was no problem in the anastomotic site, but the drainage from pleural cavity increased after oral intake. The stomach perforation was proved by rethoracotomy. The perforation site was repaired by sutures with pedicled intercostal muscle.
Drainage ; Esophageal Neoplasms* ; Intercostal Muscles ; Pleural Cavity ; Postoperative Complications ; Stomach* ; Sutures

BACKGROUND: The authors have modified the method of Ravitch technique. MATERIAL AND METHOD: This technique was applied to 6 patients out of 18 patients who underwent corrective surgery from May 1987 to July 1999. The technique is quite different from that of Ravitch. We did not divide the intercostal muscle bundles from the laterals of sternum and the Akin's struts were placed retrosternally crossing the chest horizontally to prevent flail motion during immediate post-operative period and retraction of the sternum afterwards. Anterior sternal osteotomy instead of the posterior one was performed for the latest 3 cases which made operative procedure more simple and easy. The struts were removed one year later. RESULT: Compared to the hospital stay of the patients who received standard Ravitch method that of the six cases who received our modification was definitely shortened from 13.1 days to 8.3 days(p<0.0000). Flail motion was not noted in any patient and chest wall stability was obtained more easily with this technique. CONCLUSION: Our modification is recommendable for correction of funnel chest in regards to shorter operation time better chest wall stability shorter hospital stay and less complication.
Funnel Chest* ; Humans ; Intercostal Muscles ; Length of Stay ; Osteotomy ; Sternum ; Surgical Procedures, Operative ; Thoracic Wall ; Thorax

A metastasizing pleomorphic adenoma originating from the parotid gland is a rare form of neoplasm. The neoplasm is a histologically benign, but clinically controversial entity. Herein, a case report of a pleuro-pneumonectomy of a metastasizing pleomorphic adenoma in the right lung is described. A 57-year-old man, who underwent resection of parotid gland due to a pleomorphic adenoma, presented with multiple metastases on the right lung, mediastinum, pericardium and intercostal muscle. The metastatic lesions were composed of a benign pleomorphic structure.
Adenoma, Pleomorphic* ; Humans ; Intercostal Muscles ; Lung* ; Mediastinum ; Metastasectomy ; Middle Aged ; Neoplasm Metastasis ; Parotid Gland ; Pericardium

In chest wall reconstruction after wide chest wall resection, the use of a musculocutaneous flap or prosthetic materials is inevitable for maintaining thoracic movement and a closed pleural cavity. We report a case of a 63-year-old male with a large invasive thymic carcinoma in the anterior mediastinum. The mass measured 6.8 cm and involved the sternum, left side of the parasternal area, ribs, and intercostal muscles. The patient underwent subtotal sternectomy, radical thymectomy, and reconstruction with biological mesh (Permacol). Successful chest wall reconstruction without any other complications was achieved, demonstrating the effectiveness of Permacol.
Collagen ; Humans ; Intercostal Muscles ; Male ; Mediastinum ; Pleural Cavity ; Ribs ; Sternum ; Thoracic Wall ; Thymectomy ; Thymoma

M. supracostalis anterior is a rare varlation which occurs on the external aspect of the upper thoracic wall. This thin, short-like musc1e lies deep to the pectoralis major and minor muscles, and extends longitudinally over the upper four or five ribs. It is known that the muscle usually occurs bilaterally but sometimes unilaterally. In the present report, a case of unilateral (right) M.supracostalis anterior, observed in a 58-year-old man cadaver, is described. Because the muscle had not been reported in Korea, morphological characteristics and nerve innervation of the muscle were investigated. 1. M. supracostalis anterior, observed only on the right side, extended longitudinally from the first rib to the fourth rib deep to the pectoralis minor. 2. The suprarostalis anterior arose from the antero-inferior surface below the groove for subclavian vein of the first rib. After arising from the first rib, the smaller, more media part of the muscle inserted into the upper border of the fourth rib and the larger, more lateral part inserted into the upper border of the fourth rib. 3. The length of the musce is 9.9cm, and the width is 0.8cm at its origin, 1.7cm at the upper border of the third rib and 2.4cm at the upper border of the fourth rib. 4. It was confirmed, under stereomicroscope, that the muscle was innervated by the terminal branches of the nerve to the first external intercostal muscle deriving from Thl and Th2. Blood supply of the M. supracostalis anterior was provided mainly by the lateral thoracic artery arising from the axillary artery.
Axillary Artery ; Cadaver ; Humans ; Intercostal Muscles ; Korea ; Middle Aged ; Muscles ; Ribs ; Subclavian Vein ; Thoracic Arteries ; Thoracic Wall

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Catheters* ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves ; Pain Management* ; Pain, Postoperative ; Pleura ; Respiration ; Thoracic Cavity ; Thoracotomy*

BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Arterial Pressure ; Bupivacaine ; Catheters* ; Cough ; Epinephrine ; Heart Rate ; Humans ; Intercostal Muscles ; Intercostal Nerves ; Pain Management* ; Pain, Postoperative ; Pleura ; Respiration ; Thoracic Cavity ; Thoracotomy*