Use of vacuum-assisted closure in the treatment of complex intrapleural infections

Abstract

Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure. Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression. Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p<0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p<0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07). Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting.

Keywords

• vacuum-assisted closure
• empyema
• open window thoracostomy
• fenestration
• thoracoplasty