Sziklavari, Zsolt and Ried, Michael and Neu, Reiner and Schemm, Rudolf and Grosser, Christian and Szoeke, Tamas and Hofmann, Hans-Stefan (2015) Mini-open vacuum-assisted closure therapy with instillation for debilitated and septic patients with pleural empyema. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 48 (2). E9-E16. ISSN 1010-7940, 1873-734X
Full text not available from this repository. (Request a copy)Abstract
OBJECTIVES: This prospective study is an evaluation of the mini-open vacuum-assisted closure with instillation (Mini-VAC-Instill) therapy for the treatment of complicated pleural empyema. METHODS: We investigated septic patients in poor general physical condition (Karnofsky index <= 50%) with multimorbidity and/or immunosuppression who were treated by minimally invasive intrathoracic VAC-Instill therapy without the insertion of an open-window thoracostomy (OWT) between December 2012 and November 2014. All patients underwent mini-thoracotomy with position of a tissue retractor, surgical debridement and local decortication. Surgery was followed by intrathoracic vacuum therapy including periodic instillation using antiseptics. The VAC dressings were changed under general anaesthesia and the chest wall was closed during the same hospital stay. All patients received systemic antibiotic therapy. RESULTS: Fifteen patients (13 males, median age: 71 years) underwent intrathoracic Mini-VAC-Instill dressings for the management of pleural empyema without bronchopleural fistula. The median length of vacuum therapy was 9 days (5-25 days) and the median number of VAC changes per patient was 1 (1-5). In-hospital mortality was 6.7% (n = 1) and was not related to Mini-VAC-Instill therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in 85.7% of surviving patients (12 of 14). After the follow-up at an average of 13.2 months (range, 3-25 months), we observed recurrence once, 21 days after discharge. Two patients died in the late postoperative period (Day 43 and Day 100 after discharge) of fulminant urosepsis and carcinoma-related multiorgan failure, respectively. Analysis of the follow-up interviews in the outpatient clinic showed a good quality of life and a subjectively good long-term aesthetic result. CONCLUSIONS: Mini-VAC-Instill therapy is an upgrade of Mini-VAC, which guarantees the advantage of an open treatment, including flushing but without OWT. This procedure is minimally invasive, highly compatible especially with patients in poor general condition and may be an alternative to the OWT in selected patients. Consequently, a very short course of therapy results in good patient acceptance.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | OPEN-WINDOW THORACOSTOMY; THORACIC EMPYEMA; POSTPNEUMONECTOMY EMPYEMA; INTRATHORACIC APPLICATION; LUNG RESECTION; MANAGEMENT; PERSISTENT; SURGERY; DEVICE; OPTION; Vacuum-assisted closure; Negative pressure wound therapy; Instillation; Empyema; Minimally invasive |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 Jun 2019 09:40 |
| Last Modified: | 19 Jun 2019 09:40 |
| URI: | https://pred.uni-regensburg.de/id/eprint/5106 |
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