Intrathoracic muscle flap transposition in the treatment of fibrocavernoustuberculosis

Background and objective: Conventionally, pulmonary resection with thoracop lasty is used to treat fibrocavernous complication of pulmonary tuberculosi s. This operation is usually bloody, time-consuming with complicated postop erative course. To prevent massive blood loss and preserved pulmonary funct ion, a more simplified operative procedure, cavernostomy combined intrathor acic muscle flap transposition was used and the outcome was evaluated in th is study. Design: Retrospective review. Methodology: Between December 1989 and June 1996, a total of ten patients with fibrocavernous pulmonary tuberc ulosis were managed using cavernostomy combined with intrathoracic muscle f lap transposition. Five of them had concomitant aspergilloma within the cav ity while three had multiple drug resistant pulmonary tuberculosis. The mus cle flap was used to plombage the cavity and reinforce the closure of bronc hopleural fistula after cavernostomy. Results: Six postoperative complicati ons occurred in five patients, including reformation of cavity (2), broncho pleurocutaneous fistulae (3), and postoperative bleeding (1). The success o r failure of intrathoracic muscle flap transposition on patients with fibro cavernous tuberculosis was significantly correlated with the size of the ca vity (194.0 +/- 11.2 vs. 283.0 +/- 44.6 cm(3), P = 0.016) and the number of bronchopleural fistulae (1.6 +/- 0.4 vs. 4.0 +/- 0.4, P = 0.008). There wa s no operative death and in long term follow-up, there was no recurrence of hemoptysis or deterioration of pulmonary function in the successful group of patients. Conclusions: Cavernostomy combined with intrathoracic muscle f lap transposition can be used to treat well-selected fibrocavernous pulmona ry tuberculosis patients, except on patients with large size cavity, multip le bronchopleural fistulae or multiple drug resistance tuberculosis. (C) 20 00 Elsevier Science B.V. All rights reserved.