Free Pericardial Fat Pad Patch Repair Without Parenchymal Approximation for Severe Intraoperative Air Leak: A Technique to Optimize Limited Graft Volume.

Intraoperative air leaks remain a significant challenge in thoracic surgery, particularly in patients with severe pulmonary emphysema, where conventional suture repair may exacerbate parenchymal tearing. While the use of a free pericardial fat pad (FPFP) has been reported, standard techniques typically require parenchymal approximation, which can induce tension-related injury. We describe an FPFP patch repair without parenchymal approximation, specifically designed to optimize limited graft volume. An 83-year-old male with severe bilateral emphysema underwent a left upper lobectomy for squamous cell carcinoma. During chest closure, a massive air leak became evident from an extensive pleural laceration adjacent to the hilum. Due to the fragility of the parenchyma and proximity to pulmonary vessels, direct suturing was deemed hazardous. Furthermore, as the available FPFP volume was limited because a portion had already been removed, the harvested FPFP was incised on the adipose side to expand its pleural surface area and maximize coverage. The graft was then secured as a patch over the affected area without any parenchymal approximation. The air leak was immediately resolved, and the patient's postoperative course was uneventful. FPFP patch repair without parenchymal approximation may provide a useful option for managing severe intraoperative air leaks in fragile, emphysematous lungs. The modification to expand the graft's surface area allows for successful repair even when available adipose tissue is limited.