PURPOSE: The last resort in the treatment of recurrent thoracic empyema in the presence of residual pulmonary parenchyma is an open window thoracostomy (OWT). Vacuum-assisted closure (VAC) is a new option. VAC therapy may accelerate wound healing and enhance expansion of residual lung parenchyma.
METHODS: 19 patients with residual pulmonary parenchyma received an OWT for treatment of recurrent thoracic empyema. Eight patients received conservative treatment, while eleven patients were treated with VAC.
RESULTS: In the VAC group, 6 patients had alveolopleural fistulae (APF). All 11 patients were successfully treated and were amenable for subsequent closure using pedicled muscular flaps. Application of VAC resulted in rapid debridement of the thoracic cavity and expansion of the residual lung tissue. In one patient, a new OWT was created because of recurrence of empyema. She was treated with pneumonectomy through median sternotomy. The duration of OWT and vacuum therapy were 39±17 and 31±19 days, respectively. In two patients, VAC-therapy itself resulted in complete closure of the OWT. All but one patient are doing well. One patient died of a non-pulmonary cause. In the non-VAC group (6 patients with APF), the OWT was managed conservatively with application of saline-soaked gauzes. Six patients could be discharged home. In two patients, the OWT was eventually closed (after 75 and 440 days). Four patients died during follow-up because of OWT-related complications (1 bleeding, 3 recurrent infection of the thoracic cavity), One patient died because of metastatic testis carcinoma, one patient died of sepsis. The average duration of OWT was 933±1422 days.
CONCLUSION: VAC accelerates wound healing and improves expansion of residual lung tissue in the presence of OWT.
CLINICAL IMPLICATIONS: Patients with an OWT after recurrent thoracic empyema can be successfully treated with VAC-therapy allowing rapid surgical closure.
DISCLOSURE: Meindert Palmen, None.