V.A.C.® – treatment in the thoracic cavity: Indications, advantages, method and difficulties of application

Aim: This retrospective analysis evaluates the advantages of VAC therapy for thoracostoma and presents the difficulties with the application.

Methods: From 01/04–08/07 implantation of a VAC system in the pleural cavity in 25 patients with septic complications due to bronchopleural/pleuropulmonary fistulas with bacterial contamination was performed. The indication for the thoracostoma was recurrent pleural empyema after pneumonectomy (n=6), lobectomy (n=14), empyema necessitates (n=3), recurrent segmental resection after tuberculosis (n=1), pneumonectomy after esophagectomy with insufficiency of esophagogastrostomy (n=1).

After debridement and exact hemostasis the whole thoracic cavity was completely loosely filled with the grey sponge. After the first three patients we found out that continuous suction from 50 to 100mmHg was optimal for the pleural cavity. The dressing changes were set individually but latest on the third day after application.

Results: The closed thoracostoma enabled a complete evacuation of the purulent effusion, prevented moist, suppurating dressings, avoided the maceration of the surrounding skin, stopped additive bacterial growth, increased the mobility of the patients and made care easier. A definitive closure of the thoracic cavity could be performed in all cases between the 9 th and 48 th day (mean 22, 24 days).

Conclusion: In specific indications the VAC application in the pleural cavity is a safe and efficient treatment for thoracostoma to reduce the pulmonary complications and improve the pulmonary function. The scepticism about its use with thoracostoma is not justified if the employer knows the special physical and anatomical realities of the thoracic cavity.