Document Detail


Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure.
MedLine Citation:
PMID:  19766795     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recurrent thoracic empyema in the presence of residual lung tissue can be treated with an open window thoracostomy (OWT). Vacuum-assisted closure (VAC) of these large thoracic defects is a novel option. METHODS: Nineteen patients with residual lung tissue received an OWT for treatment of recurrent thoracic empyema. In this retrospective case series, 8 patients (aged 58 +/- 20 years, all male) were treated conventionally, and 11 patients (aged 53 +/- 17 years, 8 male) were treated with VAC. RESULTS: The application of the VAC system resulted in rapid debridement of the thoracic cavity and reexpansion of the residual lung tissue. The duration of OWT and VAC therapy was 39 +/- 17 and 31 +/- 19 days, respectively. All 11 patients were amenable for subsequent closure using pedicled muscular flaps. In 2 patients, VAC therapy alone resulted in complete closure of the OWT. The average duration of follow-up was 46 +/- 19 months. All patients, except 1, have recovered well. One patient died of nonpulmonary causes. In the non-VAC group (n = 8), the OWT was managed conventionally by application of saline-soaked gauzes. In 2 patients, the OWT was eventually closed using pedicled muscular flaps (after 75 and 440 days, respectively). Four patients died of OWT-related complications (1 bleeding, 3 recurrent infections) during follow-up; 1 patient died of a cause unrelated to OWT. The average duration of OWT was 933 +/- 1,422 days. CONCLUSIONS: When compared with conventional management of OWT, VAC therapy accelerates wound healing and improves reexpansion of residual lung tissue in patients with OWT after empyema, allowing rapid surgical closure.
Authors:
Meindert Palmen; H Nathalie A M van Breugel; Gijs G Geskes; Arne van Belle; Jos M H Swennen; André H M Drijkoningen; Rene R van der Hulst; Jos G Maessen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  88     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-21     Completed Date:  2009-10-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1131-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Empyema, Pleural / diagnosis,  therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Negative-Pressure Wound Therapy / methods*
Retrospective Studies
Thoracostomy / methods*
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Ann Thorac Surg. 2009 Oct;88(4):1136-7   [PMID:  19766796 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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