Bronchial Fistula. A Method of Experimental Production.

Abstract

Bronchial fistula, a not uncommon complication following certain operations and disease conditions in man, has been found somewhat difficult to produce experimentally. This fact is substantiated by the work of Pool and Garlock, and others, who found the production of bronchial fistula in dogs attended with great technical difficulties. Their method consisted of resecting a piece of rib and suturing the underlying lung lobe to the very thin parietal pleura over an area 1.25 inches in diameter. At a second stage operation 2 weeks later, the lung parenchyma found adherent to the chest wall was entered by careful blunt dissection until a fair sized bronchus was located. This was then opened and the skin margins sutured to the opening in the bronchus. They were unable to retain this opening, however, without almost daily cauterization, as it tended to close spontaneously. Having no knowledge of the above procedure, we first attempted to produce a bronchial fistula in much the same manner, viz: At the first operation a piece of rib was resected and the underlying lung sutured to the parietal pleura and periosteum over an area 1.5 inches in diameter. At a second operation 2 weeks later, the area enclosed by the suture was entered with the actual cautery heated to a dull red until an area 1 cm. in diameter and about 1 inch in depth was burned in the lobe. The skin was sutured around the burned area. A bronchial fistula resulted; however it was very deep seated and also quite small so that this method was cast aside and the following procedure adopted. At the first operation, 2.5 inches of the right 6th rib were removed sub-periosteally at about its mid-point.