Treatment of complicated pulmonary aspergillomas with cavernostomy and muscle flap: interest of concomitant limited thoracoplasty.

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.