Reconstructive surgical treatment of tuberculosis abscess in the chest wall

Tuberculosis is presently an important health problem throughout the world. Despite its progressive decrease in developed countries, the situation has changed in recent years due to the AIDS pandemic. Among these, tuberculous abscess of the chest wall is a rare disease and an optimal treatment plan remains controversial. The authors experienced recalcitrant cases of chest wall cold abscess involving ribs and sternum recurring after local debridement treatment. Nine patients between March 2004 and December 2008 were retrospectively analyzed, focusing on their clinical features, surgical treatment consisting of wide resection and flap coverage, and long-term outcome. There was a past history of pulmonary tuberculosis in 2 patients, but no one had concomitant active pulmonary tuberculosis. Radical resection of soft tissue and the bone resulted in wide defect, which could be covered by a local myocutaneous flap. In all patients, histologic findings of the debrided specimen showed typical lesions of tuberculosis, caseous necrosis with a tuberculoid granulomatous inflammatory infiltrate. Postoperative progress was good and there was no complication of donor site. The patients were started on antituberculosis therapy. They remain well during follow-up period (mean: 22 months). We conclude that cold abscess of the chest wall must be treated more aggressively, and meticulous debridement and wide resection including involved bones and cartilages is required followed by coverage with local muscle or musculocutaneous flaps.