Abstract
INTRODUCTION
The surgical treatment of tuberculous caverns populated by mycosis is dominated by lung resections, be they anatomical or wedge resections. There are some patients who have co-morbidities or limited functional respiratory status that make these types of surgery impossible. Our aim is to present an alternative surgical procedure to treat this patient category.
MATERIAL AND METHODS
An alternative for surgical treatment with a lower impact for the patient is to fill the cavern with a vascular axis pedicle muscle flap. We took into account patients with ASA risk class higher than 3, with FEV and FVC lower than 40%. We applied this treatment to 7 patients that met the criteria for the patient lot.
RESULTS
For the 7 patients, after thoracotomy, cavernotomy, excision of the micetoma, the suture of the bronchial fistulae, we used to fill the cavities the following muscles: pectoris major – 2 cases, intercostal muscle – 4 cases and latissimus dorsi – 1 case. The immediate outcome was favorable in all cases except one for whom we had to re-operate for bleeding. In all cases the viability of the transposed muscle was not affected.
CONCLUSIONS
The aim of the surgical treatment is to evacuate the micetoma, but wedge or anatomical resections for these cases have major complications. We can consider various techniques for thoracoplasty but the scale of the intervention and the duration make us reluctant. Our experience is limited by the number of cases, but in these critical cases the usage of muscle flaps gave us satisfaction.
- © 2013 ERS