PURPOSE: The conventional management of postpneumonectomy and postlobectomy empyema necessitates an open window, wound packing, frequent wound debridement and prolonged hospitalization. We studied the feasibility of outpatient therapy of these patients using the Vacuum Assisted Closure (VAC)Therapy System.
METHODS: From 9/05 to 3/08 6 patients with postlobectomy and postpneumonectomy empyema with or without a bronchopleural fistula underwent outpatient therapy using a VAC system. After exploration, debridement, and closure of the bronchial fistula, a VAC System was applied with a portable suction device set at 75 mm Hg. The patient was discharged and returned for weekly debridement under anesthesia and VAC replacement.Once the pleural space was clean enough, the bronchial stump was closed with 000 PDS, the residual space was obliterated, and the wound was closed over suction catheters.
RESULTS: There were 5 men and 1 women. Mean age: 55.5 ( range 23–72). 4 Postlobectomy and 2 Postpneumonectomy empyema. 4/6 (67%) had a bronchial fistula. 5/6 (83%) had surgery for cancer. 4/5 (80%) patients had received induction therapy. Mean time from VAC placement to closure was 63.1 days with an average of 9 VAC changes. All wounds were closed with an omental flap and rectus abadominus and serratus anterior muscles. At a mean followup of 13 months there have been no failures.
CONCLUSION: Although further experience is necessary, out patient therapy using a VAC system is feasible in the postpneumonectomy and postlobectomy empyema patient.
CLINICAL IMPLICATIONS: The strategy may significantly decrease the morbidity and the prolonged hospitalization which has been associated with the care of patients with postpneumonectomy and postlobectomy empyema.
DISCLOSURE: Barbara Tempesta, No Financial Disclosure Information; No Product/Research Disclosure Information