Bucket-handle repair of a tear in the bronchus intermedius with an intercostal muscle flap

As previously well described in the literature, the intercostal muscle (ICM) flap can be used to buttress bronchial stumps following lung resection. We describe a harvesting technique of ICM flap which enabled a bi-lobectomy to be avoided in a patient with poor pulmonary function. The Key to this technique is the preservation of the neurovascular bundle. Therefore the flap is not divided anteriorly thereby differentiating it from any previous technique described.We have called it the 'bucket handle' technique, which was used to repair an intra-operative tear in bronchus intermedius. Its efficacy was tested to the full when the patient developed severe adult respiratory distress syndrome (ARDS) secondary to pseudomonas pneumonia and required high-pressure mechanical ventilation. This case demonstrates that ICM flap is an effective buttress to bronchial stumps or repairs and offers reassurance for optimal outcome due to its intact vascular pedicle.