Document Detail

Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure.
MedLine Citation:
PMID:  19766795     Owner:  NLM     Status:  MEDLINE    
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.
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    
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
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MeSH Terms
Aged, 80 and over
Empyema, Pleural / diagnosis,  therapy*
Follow-Up Studies
Middle Aged
Negative-Pressure Wound Therapy / methods*
Retrospective Studies
Thoracostomy / methods*
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
Comment In:
Ann Thorac Surg. 2009 Oct;88(4):1136-7   [PMID:  19766796 ]

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