Rupture of the esophagus into the space left after pneumonectomy is a rare and often fatal complication. Esophagopleural fistulas occurred in three patients following pneumonectomy. After previous methods failed, two patients were successfully treated by using a one-stage procedure which included (1) suture closure of the fistula, (2) buttressing the repair with a viable, pedicled, two-rib intercostal-muscle flap, and (3) performing an extensive thoracoplasty with a continuous drip infusion of neomycin. Such a procedure offers the maximum opportunity for successful treatment of this catastrophic lesion.