381192b9c492d124fe8f35e49c6e5af6 jcm-15-04574.pdf 89e5df7b215faa974146a44d3894ebe5e7f35a46 jcm-15-04574.pdf 6685bc3bebb14435681cca6615168f2883a142962ae4ffe80122fba2be2f7226 jcm-15-04574.pdf Title: Open-Window Thoracostomy Closure Using a Free Musculocutaneous Flap, Fascia Patch Graft, and Postoperative Compression Guided by Near-Infrared Spectroscopy: A Case Report Subject: Bronchopleural fistula is a rare but severe complication of lung resection, associated with significant morbidity and mortality, especially when an open-window thoracostomy is required. The clinical and surgical management is complex and becomes even more challenging in the presence of underlying conditions such as recurrent infections or malignancy. Postoperative management is equally demanding, as local compression may help prevent fistula recurrence but can compromise flap perfusion. A 65-year-old male with a history of right upper lobectomy and subsequent sublobar resection for lung adenocarcinoma presented with an 8 4 cm open-window thoracostomy complicated by chronic bronchopleural fistula and empyema. Extensive fibrosis of the surrounding tissues, including the ipsilateral latissimus dorsi muscle, limited the available reconstructive locoregional options. Reconstruction was performed using primary fistula closure reinforced with a contralateral free latissimus dorsi musculocutaneous flap and a fascia patch graft secured with cyanoacrylate-based bioadhesive. Postoperatively, continuous near-infrared spectroscopy monitoring enabled safe application of compressive bandage while minimizing the risk of flap perfusion compromise. Complete fistula closure was achieved. Apart from a surgical site abscess requiring debridement on postoperative day 7, no further complications occurred. At the 2-year follow-up, the patient remains free of fistula recurrence, wound dehiscence, or oncological relapse. We describe a novel approach for open-window thoracostomy closure combining a free musculocutaneous flap with a fascia patch graft reinforced by bioadhesive, together with postoperative perfusion monitoring using near-infrared spectroscopy. This strategy may help address both the reconstructive and postoperative challenges associated with complex bronchopleural fistulas. Keywords: open-window thoracostomy; free flap; postoperative monitoring; compression; near-infrared spectroscopy Author: Paloma Malagón, Cristian Carrasco, Carlos Martinez-Barenys, Sebastián Peñafiel, Martin Marzabal, Linda Klimavicius Palma and Carmen Higueras Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri Jun 12 14:29:51 2026 CEST ModDate: Fri Jun 12 14:45:08 2026 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 22701888 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GUOZOO+URWPalladioL-Ital Type 1 Custom yes yes yes 71 0 DVCMRV+CMSY10 Type 1 Builtin yes yes yes 72 0 JZBMOC+URWPalladioL-Bold Type 1 Custom yes yes yes 73 0 MIKRSI+VnURWPalladioL Type 1 Custom yes yes yes 74 0 PQULBO+URWPalladioL-Roma Type 1 Custom yes yes yes 75 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-09-05 04:34:52 CEST RepresentationInformation: jcm-15-04574.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-09-04 13:58:31 CEST Size: 22701888 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 273 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Case Report Item: Title: Postoperative Management Item: Title: Follow-Up Item: Title: Discussion Item: Title: Conclusions Item: Title: References Info: Title: Open-Window Thoracostomy Closure Using a Free Musculocutaneous Flap, Fascia Patch Graft, and Postoperative Compression Guided by Near-Infrared Spectroscopy: A Case Report Author: Paloma Malagón, Cristian Carrasco, Carlos Martinez-Barenys, Sebastián Peñafiel, Martin Marzabal, Linda Klimavicius Palma and Carmen Higueras Subject: Bronchopleural fistula is a rare but severe complication of lung resection, associated with significant morbidity and mortality, especially when an open-window thoracostomy is required. The clinical and surgical management is complex and becomes even more challenging in the presence of underlying conditions such as recurrent infections or malignancy. Postoperative management is equally demanding, as local compression may help prevent fistula recurrence but can compromise flap perfusion. A 65-year-old male with a history of right upper lobectomy and subsequent sublobar resection for lung adenocarcinoma presented with an 8 4 cm open-window thoracostomy complicated by chronic bronchopleural fistula and empyema. Extensive fibrosis of the surrounding tissues, including the ipsilateral latissimus dorsi muscle, limited the available reconstructive locoregional options. Reconstruction was performed using primary fistula closure reinforced with a contralateral free latissimus dorsi musculocutaneous flap and a fascia patch graft secured with cyanoacrylate-based bioadhesive. Postoperatively, continuous near-infrared spectroscopy monitoring enabled safe application of compressive bandage while minimizing the risk of flap perfusion compromise. Complete fistula closure was achieved. Apart from a surgical site abscess requiring debridement on postoperative day 7, no further complications occurred. At the 2-year follow-up, the patient remains free of fistula recurrence, wound dehiscence, or oncological relapse. We describe a novel approach for open-window thoracostomy closure combining a free musculocutaneous flap with a fascia patch graft reinforced by bioadhesive, together with postoperative perfusion monitoring using near-infrared spectroscopy. This strategy may help address both the reconstructive and postoperative challenges associated with complex bronchopleural fistulas. 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