title: Surgical treatment of chronic pulmonary aspergillosis using preventive latissimus dorsi muscle flaps.
abstract: BACKGROUND
  Surgery for chronic pulmonary aspergillosis is often technically risky. The choice of immediate thoracoplasty or muscle flap plombage to prevent postoperative space problems remains controversial. This study focused on the use of muscle flaps to prevent postoperative complications.
  
  
  METHODS
  During an 8-year period (2004 to 2012), all patients surgically treated for chronic pulmonary aspergillosis were enrolled in this retrospective study. Concomitant intrathoracic transposition of the latissimus dorsi muscle flap has been performed since 2011. The clinical records of these patients were reviewed retrospectively.
  
  
  RESULTS
  From 2004 to 2012, 16 patients were treated for chronic pulmonary aspergillosis. Fifteen patients received lobectomies and one had a partial resection. A preventive latissimus dorsi muscle flap was used in 6 patients (37 %). No postoperative deaths occurred. Prolonged air leaks appeared in 2 patients without muscle flaps, resulting in empyema in both. None of the patients with preventive muscle flaps suffered prolonged air leaks and subsequent empyema. In the outpatient clinic, late onset air leaks developed in 2 patients, one of whom had a lobectomy with muscle flap while the other had a lobectomy without muscle flap. Residual pleural space persisted in these two patients and Aspergillus infection later recurred.
  
  
  CONCLUSIONS
  Concomitant latissimus dorsi muscle flaps may be effective for the prevention of prolonged air leaks and subsequent empyema. Late onset air leaks are problematic.
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan. hata@med.toho-u.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hata
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan. hajime.ootsuka@med.toho-u.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Otsuka
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan. tmakino0731@gmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Makino
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan. satoshi.koezuka@med.toho-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koezuka
authors.affiliation: Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan. ks142129_ikusou@ybb.ne.jp.
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugino
authors.affiliation: Department of Radiology, Toho University School of Medicine, Tokyo, Japan. n.shiraga@nifty.com.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shiraga
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan. naobumi.tochigi@med.toho-u.ac.jp.
authors.forename: Naobumi
authors.initials: N
authors.lastname: Tochigi
authors.affiliation: Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan. kaz@med.toho-u.ac.jp.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Shibuya
authors.affiliation: Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan. sahomma@med.toho-u.ac.jp.
authors.forename: Sakae
authors.initials: S
authors.lastname: Homma
authors.affiliation: Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan. aiyoda@med.toho-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Iyoda
mesh_terms: D000368:Aged; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055732:Pulmonary Aspergillosis / Q000601:surgery*; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000601:surgery; D013524:Surgical Flaps; D013905:Thoracoplasty; D016896:Treatment Outcome