Document Detail


Vacuum-assisted closure for the treatment of complex chest wounds.
MedLine Citation:
PMID:  15797049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Destruction of chest wall musculature from trauma, empyema, or local infection limits closure options, especially with muscle flaps. While the vacuum-assisted closure system (VAC; KCI International, San Antonio, TX) has been used for wounds in other anatomic locations, we have found no series for chest wounds. METHODS: This is a retrospective review of trauma registry data from the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine from 2000 to 2003. RESULTS: Seventeen patients were identified and divided into two groups. Group I consisted of seven patients with primary chest wall processes: four necrotizing soft-tissue infections and three with thoracic trauma resulting in significant loss of chest wall musculature. Group II consisted of ten patients with empyema and varying levels of chest wall extension. Six were postpneumonic and four postoperative. Wound size averaged 16 x 7 cm (range, 7 x 3 cm to 21 x 11 cm). The VAC duration averaged nine days (range, 3 to 21 days) and changed every two to three days. Fourteen wounds were culture positive; nine staphylococcus aureus, two alpha hemolytic streptococcus, and one each with enterococcus, Citrobacter, and anaerobes. Eight were polymicrobial. There were no deaths. All wounds healed without rotational muscle flaps. Ten underwent delayed primary closure, four split-thickness skin graft, and three healed by secondary intention. There was one significant complication: a wound infection after delayed primary closure which required reoperation. CONCLUSIONS: Closure of complex chest wall wounds can present significant technical challenges. The VAC system is a simple, useful, and novel alternative to conventional wound care even with large, infected wounds.
Authors:
James O'Connor; Amy Kells; Sharon Henry; Thomas Scalea
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-30     Completed Date:  2006-08-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1196-200     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Vascular Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. joconnor@umm.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Debridement
Empyema, Pleural / surgery*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retrospective Studies
Soft Tissue Infections / surgery*
Soft Tissue Injuries / surgery
Surgical Flaps
Thoracic Injuries / surgery*
Treatment Outcome
Vacuum*

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


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