1. Video-Assisted Intercostal Muscle Flaps for Bronchial Stump Coverage
Derek R. Serna-Gallegos, MD, Robert J. McKenna, MD 
The Annals of Thoracic Surgery 
Volume 103, Issue 2, Pages e215-e217 (February 2017)
DOI: /j.athoracsur
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Intercostal muscle (ICM) of interest within utility incision is dissected from subcutaneous fat with blunt dissection and Army-Navy retractor at wound site. Periosteal elevator is used to separate ICM from its superior and inferior attachments to rib in subperiosteal plane.
The Annals of Thoracic Surgery  , e215-e217DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Dissection in subperiosteal plane is continued posteriorly through utility incision with periosteal elevator using camera through camera port to guide dissection. Intercostal muscle (ICM) can be divided anteriorly at most anterior extent that is exposed through utility incision.
The Annals of Thoracic Surgery  , e215-e217DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Several polyglactin sutures are placed through divided bronchial stump and tied in middle of suture. Muscle flap can then be passed over bronchial stump and between tails of suture, which are then tied down again to secure muscle flap in place.
The Annals of Thoracic Surgery  , e215-e217DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions