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  • Title: Treatment of complicated pulmonary aspergillomas with cavernostomy and muscle flap: interest of concomitant limited thoracoplasty.
    Author: Grima R, Krassas A, Bagan P, Badia A, Le Pimpec Barthes F, Riquet M.
    Journal: Eur J Cardiothorac Surg; 2009 Nov; 36(5):910-3. PubMed ID: 19595606.
    Abstract:
    OBJECTIVE: Lung resection for complex aspergilloma (CA) carries high morbidity and mortality and remains controversial in high-risk patients. Cavernostomy followed by muscle-flap plombage has been recommended for patients considered unfit for resection, but subsequent muscle-flap atrophy may be a main cause of failure. We reviewed the place of a limited thoracoplasty in association with that procedure. METHODS: Five patients complaining of haemoptysis related to CA were denied lung resection because of bilateral lung destruction (n=1), and required completion pneumonectomy (previous lobectomy for cancer followed by adjuvant radiation therapy, n=4). We analysed the data concerning the alternative surgical procedures performed and their immediate and late results. RESULTS: The surgery consisted in cavernostomy, removal of the fungus ball, cavity obliteration with the most directly available muscle flaps (rhomboid muscle n=2, trapezius and rhomboid n=2, serratus major and subscapular n=1). A limited thoracoplasty ranging from 2 to 5 portions of rib (mean resected rib portions n=3.4) was performed in addition to this procedure. The postoperative course was uneventful. All patients are still alive (mean follow-up 3 years; range: 1-6 years) and faring well without thoracoplasty-related aftereffect, complication related to muscle-flap disuse atrophy nor recurrence of the disease. CONCLUSION: Cavernostomy followed by muscle transposition has been reported to provide encouraging results. Combining a limited thoracoplasty during the same operation is a simple, safe and well-tolerated procedure regularly achieving good results, and thus deserving consideration.
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