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Prophylactic use of vascularized flaps to buttress and reinforce bronchial or oesophageal closure is nowadays the preferred approach in high-risk cases, especially for extended resections with tracheobronchial reconstructions or after neoadjuvant chemoradiotherapy. However, the majority of these options and techniques are described for an approach through a thoracotomy. Due to anatomical restrictions, these options are less suitable when a trans-sternal approach is used. We emphasize the use of an internal mammary artery pedicle as prophylactic flap coverage in 3 high-risk cases, all operated on through a median sternotomy.

Internal mammary artery pedicle: a solution for prophylactic flap coverage in high-risk trans-sternal thoracic surgery