Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system

Purpose The conventional management of a post-pneumonectomy (PPE) and post-lobectomy empyema (PLE) necessitates an open window, wound packing, frequent wound debridement, and prolonged hospitalization. We studied the feasibility of outpatient therapy in this patient population using the vacuum-assis...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2010-08, Vol.40 (8), p.711-718
Main Authors: Al-Mufarrej, Faisal, Margolis, Marc, Tempesta, Barbara, Strother, Eric, Gharagozloo, Farid
Format: Article
Language:English
Subjects:
Adult
Aged
Empyema, Pleural - etiology
Empyema, Pleural - surgery
Female
Hospitalization
Humans
Length of Stay - statistics & numerical data
Male
Medicine
Medicine & Public Health
Middle Aged
Negative-Pressure Wound Therapy - instrumentation
Negative-Pressure Wound Therapy - methods
Original Article
Outpatients - statistics & numerical data
Pneumonectomy - adverse effects
Postoperative Complications
Postoperative Period
Retrospective Studies
Surgery
Surgical Oncology
Time Factors
Treatment Outcome
Young Adult
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Summary:Purpose The conventional management of a post-pneumonectomy (PPE) and post-lobectomy empyema (PLE) necessitates an open window, wound packing, frequent wound debridement, and prolonged hospitalization. We studied the feasibility of outpatient therapy in this patient population using the vacuum-assisted closure (VAC) therapy system. Methods From September 2005 to November 2007, six patients with PPE and PLE with or without a bronchopleural fistula underwent outpatient therapy using a VAC system. After debridement and closure of the bronchial fistula, a VAC system was applied and the patient was discharged. The patient returned for debridement under anesthesia and VAC replacement every 7–10 days. Once the pleural space was cleaned, the residual space was obliterated, and the wound was closed over suction catheters. Of the six patients, two developed recurrent infection after the closure that required repeated VAC dressings and flap closures. Results The outpatient use of the VAC system in patients with PPE and PLE avoided the need for any daily painful dressing changes and significantly decreased the total length of hospitalization and the time to closure of the empyema space, and thus increased the overall patient satisfaction. Conclusions Our results suggest that outpatient VAC therapy of PPE and PLE is feasible and beneficial.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-008-4096-9