Intrathoracic application of negative-pressure or vacuum wound therapy following thoracic empyema surgery

Objective: Negative pressure or vacuum wound therapy (NPVWT) is an established non-invasive active therapy to promote healing of difficult wounds that fail to conventional treatment.

We report our experience of the intrathoracic application of a NPVWT-system after failed thoracic surgery for pleural empyema.

Methods: Twenty one patients (15 men, 6 women) with a median age of 55 years (range 51 to 82 years) with deep wound infections after thoracotomy and decortication for empyema were treated primarily with NPVWT after initial surgical debridement. All patients had an increased risk for impaired wound healing (e.g. diabetes, obesity, steroids, redo and empyema). The NPVWT-system was removed when systemic signs of infection resolved and quantitative cultures were negative.

Results: After a mean time of 56±44 days (range 7 to 141 days) the NPVWT-system was removed in all patients. It was used as a bridge to reconstructive surgery (latissimus dorsi muscle flap) in 1 patient (4.8%) and an adjunct in patients undergoing thoracic window surgery (n=9 (43%). Surgical wound closure could be achieved in 10 patients (48%). However, complete healing without recurrence was achieved in 16/21 (76%) patients to date. Hemodynamic or respiratory complications (e.g. air leakage) during NPVWT were observed in no case. Survival was 95% after 2.3±2 years. Duration of hospital stay varied from 16 to 141 days (mean 49±34 days).

Conclusions: Intrathoracic NPVWT after extended thoracic surgery for empyema seems to be an effective and safe adjunct to conventional treatment modalities for the therapy of chronic pleural empyema.