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Stüben BO, Plitzko GA, Sauerbeck J, Busch P, Melling N, Reeh M, Izbicki JR, Rösch T, Bachmann K, Tachezy M. Minimally invasive intrathoracic negative-pressure therapy and flexible thoracoscopy (FlexVATS) for patients with pleural empyema. Sci Rep 2023; 13:10869. [PMID: 37407677 DOI: 10.1038/s41598-023-37961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
To determine whether a new surgical method using a flexible endoscope (FlexVATS) to perform sparing debridement and apply negative-pressure therapy without extensive decortication may be an alternative treatment option for empyema. Surgical treatment of pleural empyema is associated with considerable postoperative complications and mortality rates, and alternative treatment options are being explored to improve patient outcomes. This was a prospective case series. Seventeen consecutive patients treated with FlexVATS between February 2021 and August 2022 were included in the study. Only patients for whom FlexVATS was the first therapeutic intervention for pleural empyema were included. Treatment success, defined as infection resolution, was the primary endpoint of the study. The secondary endpoints were length of hospital stay, 90-day mortality, and empyema cavity volume reduction. Patients who had previously been treated for pleural empyema by either drainage or surgery were excluded. The trial was performed as a single-centre study at a tertiary medical centre in Germany. In total, 17 patients with pleural empyema were included in the study. The median (IQR) duration of vacuum treatment was 15 days (8-35 days). Twelve of the 17 (71%) patients were successfully treated, and a significant reduction in the empyema cavity volume was observed. 41% of the dressing changes were performed outside the operating room. Compared with a historic cohort of conventionally treated patients (decortication via VATS or thoracotomy), the 90-day mortality rates tended to be lower without reaching statistical significance. Three patients (18%) died in hospital during treatment. No negative pressure-therapy-related complications were observed. FlexVATS therapy is a promising alternative therapy for both healthy and debilitated patients with pleural empyema. Larger randomised trials are required to validate this treatment option.
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Affiliation(s)
- Björn-Ole Stüben
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Gabriel A Plitzko
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julia Sauerbeck
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Philipp Busch
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kai Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Stüben BO, Plitzko GA, Reeh M, Melling N, Izbicki JR, Bachmann K, Tachezy M. Intrathoracic vacuum therapy for the therapy of pleural empyema-a systematic review and analysis of the literature. J Thorac Dis 2023; 15:780-790. [PMID: 36910103 PMCID: PMC9992597 DOI: 10.21037/jtd-22-1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/25/2022] [Indexed: 03/06/2023]
Abstract
Background Pleural empyema is a serious and potentially deadly disease leading to a significant burden on health care systems. Conservative and surgical treatment results remain poor, with high morbidity and mortality rates. Patients with pleural empyema are often multimorbid and poor candidates for surgery. Therefore, it appears sensible to explore alternative, less invasive treatment options. Recently, the well-established vacuum sponge therapy has been adopted in the treatment of pleural infections. The goal of this systematic review was to identify the existing literature and reported results of vacuum therapy for pleural empyema. Methods A systematic search of MEDLINE and the Cochrane Database was performed independently by two reviewers using predefined criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. In addition, abstracts from selected conference proceedings were screened and reference scanning of the search results was performed. Single case reports were excluded. Results Fourteen studies met the selection criteria and were reviewed. A total of 165 patients were treated with vacuum therapy in the studies reviewed. 61.2% of the patients had pleural empyema secondary to thoracic surgery. In 71.5% of the patients, vacuum therapy was applied following open window thoracostomy (OWT). Mortality rates of 0-33% were reported for vacuum therapy after OWT and 0-9.3% for vacuum therapy without OWT. Length of hospital stay (LOHS) ranged from 44-217 days for patients after OWT and could not be analysed for vacuum therapy without OWT due to lacking data. Median treatment time was 7-14 days. Treatment related complications were rare overall. Success rates defined as infection resolution were high irrespective of previous treatment and cause of empyema. Conclusions The current literature shows that pleural vacuum therapy is a promising, safe, and feasible treatment alternative to existing treatment modalities for pleural empyema. However, the evidence for vacuum therapy without OWT is poor, and further data, optimally prospective or randomised control trials comparing the conventional surgical approach of video-assisted thoracoscopic surgery (VATS) decortication and minimally invasive vacuum therapy, are needed.
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Affiliation(s)
- Björn-Ole Stüben
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel A Plitzko
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Añón O, Armbruster K, Bonifazi M, Poole S, Harris EK, Elia S, Krenke R, Mariani A, Maskell NA, Polverino E, Porcel JM, Yarmus L, Belcher EP, Opitz I, Rahman NM. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J 2023; 61:2201062. [PMID: 36229045 DOI: 10.1183/13993003.01062-2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
Pleural infection is a common condition encountered by respiratory physicians and thoracic surgeons alike. The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) established a multidisciplinary collaboration of clinicians with expertise in managing pleural infection with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified: 1) epidemiology of pleural infection, 2) optimal antibiotic strategy, 3) diagnostic parameters for chest tube drainage, 4) status of intrapleural therapies, 5) role of surgery and 6) current place of outcome prediction in management. The literature revealed that recently updated epidemiological data continue to show an overall upwards trend in incidence, but there is an urgent need for a more comprehensive characterisation of the burden of pleural infection in specific populations such as immunocompromised hosts. There is a sparsity of regular analyses and documentation of microbiological patterns at a local level to inform geographical variation, and ongoing research efforts are needed to improve antibiotic stewardship. The evidence remains in favour of a small-bore chest tube optimally placed under image guidance as an appropriate initial intervention for most cases of pleural infection. With a growing body of data suggesting delays to treatment are key contributors to poor outcomes, this suggests that earlier consideration of combination intrapleural enzyme therapy (IET) with concurrent surgical consultation should remain a priority. Since publication of the MIST-2 study, there has been considerable data supporting safety and efficacy of IET, but further studies are needed to optimise dosing using individualised biomarkers of treatment failure. Pending further prospective evaluation, the MIST-2 regimen remains the most evidence based. Several studies have externally validated the RAPID score, but it requires incorporating into prospective intervention studies prior to adopting into clinical practice.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, University of Hull, Hull, UK
| | - Rachelle Asciak
- Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth, UK
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Olalla Castro-Añón
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo y Monforte de Lemos, Lugo, Spain
- C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Karin Armbruster
- Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sarah Poole
- Department of Pharmacy and Medicines Management, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elinor K Harris
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Policlinico Tor Vergata, Rome, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Alessandro Mariani
- Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clnicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Jose M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Chinese Academy of Medical Health Sciences, University of Oxford, Oxford, UK
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4
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Alreshaid F, Aljehani Y. Modified application of vacuum-assisted closure in thoracic surgery patients. J Wound Care 2022; 31:S5-S9. [DOI: 10.12968/jowc.2022.31.sup4.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Surgical site infection (SSI), ranging from superficial, deep and to organ space, is one of the major predictors for morbidity and mortality in patients undergoing thoracic surgery. Care to accelerate SSI healing is taken to shorten hospital stay and reduce costs. The deep application of vacuum-assisted closure (VAC) in thoracic patients is not well established in the literature. In this study, the deep application and safety of VAC therapy in patients with various thoracic pathologies was evaluated. Method: A retrospective chart review of all patients who were admitted to the thoracic surgery service between July 2014 and July 2018 and who developed deep SSI was carried out. Results: A total of 12 patients were included, and their demographic data analysed. There were various thoracic pathologies complicated with postoperative deep SSI treated with VAC. The duration of VAC application ranged from 4–40 days with an average hospital stay of 37.6 days. All patients showed clinical, radiological and microbiological improvement rather than developing complications except for one case of mortality due to septicaemia. Conclusion: In this study, partial intrapleural VAC therapy was safe for use in patients who underwent thoracic surgery, regardless of the underling pathology, with caution (i.e., with continued monitoring of the patient's tolerance to the treatment). The overall hospital stay may be reduced with the use of VAC. It also decreased perioperative morbidity, secondary to wound infection.
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Affiliation(s)
- Farouk Alreshaid
- Thoracic Surgery Division, Department of Surgery – King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University. Saudi Arabia
| | - Yasser Aljehani
- Thoracic Surgery Division, Department of Surgery – King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University. Saudi Arabia
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Intrathoracic negative pressure therapy and/or endobronchial valve for pleural empyema minimal invasive management: case series of thirteen patients and review of the literature. Wideochir Inne Tech Maloinwazyjne 2020; 15:588-595. [PMID: 33294074 PMCID: PMC7687666 DOI: 10.5114/wiitm.2020.93210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/20/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction Intrathoracic negative pressure therapy is an adjunct to standard methods of complex empyema management in debilitated patients. Nevertheless, the use of endoscopic one-way endobronchial valves to successfully close large bronchopleural fistulas in patients with advanced pleural empyema has been described in only a few case reports. Aim To present our experience in managing complex pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation. Material and methods We retrospectively analyzed data from 13 consecutive patients (11 men, mean age: 56 years, range: 38–80 years) who were treated for pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation between October 2015 and November 2017. Results The control of empyema was satisfactory in 12 patients; however, 1 patient died from sepsis-related multiorgan failure despite complete cessation of air leak on day 9 after endobronchial valve implantation. The overall success rate for the final closure of the chest wall was 9/12 patients (75%): in 5 patients, the wall closed spontaneously, and in 4, the wall was closed using thoracomyoplasty. Conclusions Thoracostomy with intrathoracic negative pressure therapy, endobronchial valve implantation with tube drainage, and a combination of the two could adequately manage patients with pleural empyema with or without a persistent air leakage fistula.
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6
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Ludwig C. [Surgical treatment of tracheopleural and bronchopleural fistulas after bronchoplastic resection (sleeve or bifurcation resection)]. Chirurg 2019; 90:704-709. [PMID: 31209516 DOI: 10.1007/s00104-019-0987-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment of tracheopleural and bronchopleural fistulas at an anastomosis after sleeve resection is complex and fraught with complications. Morbidity and mortality are very high. Therefore, great care must be taken to avoid such complications. The clinical signs and the early diagnosis of a potentially critical anastomosis or anastomotic leakage as well as the treatment, including secondary pneumonectomy are presented.
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Affiliation(s)
- C Ludwig
- Klinik für Thoraxchirurgie, Florence Nightingale Krankenhaus, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Kreuzbergstr. 79, 40489, Düsseldorf, Deutschland.
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7
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Castro JCD, Coltro PS, Jorge JLG, Farina Junior JA. Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment. Int Wound J 2018; 16:559-563. [PMID: 30379394 DOI: 10.1111/iwj.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022] Open
Abstract
Scalping is considered a complex wound with difficult treatment, requiring early surgical intervention, reconstructive plastic surgery, and a multidisciplinary team. The reconstruction of the scalp frequently requires a combination of therapies, including temporary coverage, such as negative pressure wound therapy (NPWT). Complications of NPWT, such as bleeding, infection, and pain, have been described. However, there is no report of acute otitis externa (AOE) because of NPWT. In this article, we present an unprecedented clinical case - a female patient who developed AOE after scalping treatment with NPWT applied over the head and ear canal. We consider that it may be a result of the direct physical action of subatmospheric pressure, the presence of dressing covering the external meatus, and alteration of the bacterial population.
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Affiliation(s)
- Júlio C D Castro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Pedro S Coltro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - João L G Jorge
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | - Jayme A Farina Junior
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
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8
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Negative pressure wound closure system for giant thoracic defect closure in a patient with completely visible pericardium: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:668-672. [PMID: 32082815 DOI: 10.5606/tgkdc.dergisi.2018.15703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/17/2018] [Indexed: 11/21/2022]
Abstract
Negative pressure wound closure system facilitates wound closure via wound contraction. In this article, we report a successful application of thoracic negative pressure wound closure system to fill the thoracic defect, control infection, and expand the lung in a 35-year-old male patient with threerib defect, lung parenchyma injury, empyema, left complete pneumothorax, and visible pericardium after gunshot injury. The excellent result obtained in our patient demonstrates that negative pressure wound closure system is a good choice for treating high-energy thoracic injuries by reducing wound infection and enabling early wound closure.
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9
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Management of Traumatic Hemothorax, Retained Hemothorax, and Other Thoracic Collections. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0101-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA, Hecker A. Stage-directed therapy of pleural empyema. Langenbecks Arch Surg 2016; 402:15-26. [DOI: 10.1007/s00423-016-1498-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
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Combined Clagett procedure, negative pressure therapy, and thoracomyoplasty for treatment of late-onset postpneumonectomy empyema necessitatis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:259-61. [PMID: 26702286 PMCID: PMC4631922 DOI: 10.5114/kitp.2015.54466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 03/31/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022]
Abstract
Late-onset post-pneumonectomy empyema necessitatis can occur many years after the surgery and is a life-threatening condition. A 58-year-old male presented with empyema necessitatis 18 years after undergoing pneumonectomy. He was successfully treated with a modified two-stage Clagett procedure and ambulatory negative pressure as the bridge between the stages. The 72-month follow-up was uneventful. The complete obliteration of the rigid and wide residual postpneumonectomy cavity was necessary to avoid re-recurrence of the infection.
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12
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Sziklavari Z, Ried M, Neu R, Schemm R, Grosser C, Szöke T, Hofmann HS. Mini-open vacuum-assisted closure therapy with instillation for debilitated and septic patients with pleural empyema. Eur J Cardiothorac Surg 2015; 48:e9-16. [DOI: 10.1093/ejcts/ezv186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
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13
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Li Z, Yu A. Complications of negative pressure wound therapy: a mini review. Wound Repair Regen 2015; 22:457-61. [PMID: 24852446 DOI: 10.1111/wrr.12190] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Abstract
Negative pressure wound therapy, with its wide indications and narrow contraindications, has been widely used for various complicated wounds. Despite its excellent properties in promoting wound healing, there are sporadic but increasing reports on the complications. These complications included bleeding, infection, pain, rupture of the heart, and death in the short term. When used for the long term, the therapy may decrease life quality, increase anxiety, and lead to malnutrition. In this review, we briefly summarize the complications of negative pressure wound therapy.
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Affiliation(s)
- Zonghuan Li
- Department of Micro-Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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14
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van Wingerden JJ, Lapid O. eComment. Avoiding pressure competition between negative pressure wound therapy for poststernotomy mediastinitis and chest drains. Interact Cardiovasc Thorac Surg 2015; 20:272-3. [PMID: 25605824 DOI: 10.1093/icvts/ivu437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Oren Lapid
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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15
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Sziklavari Z, Ried M, Hofmann HS. Vacuum-assisted closure therapy in the management of lung abscess. J Cardiothorac Surg 2014; 9:157. [PMID: 25193086 PMCID: PMC4172792 DOI: 10.1186/s13019-014-0157-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Despite significant advances in the treatment of thoracic infections, complex lung abscess remains a problem in modern thoracic surgery. We describe the novel application of vacuum-assisted closure for the treatment of a lung abscess. The technical details and preliminary results are reported. METHODS After the initial failed conservative treatment of an abscess, minimally invasive surgical intervention was performed with vacuum-assisted closure. The vacuum sponges were inserted in the abscess cavity at the most proximal point to the pleural surface. The intercostal space of the chest wall above the entering place was secured by a soft tissue retractor. The level of suction was initially set to 100 mm Hg, with a maximum suction of 125 mm Hg. The sponge was changed once on the 3rd postoperative day. RESULTS The abscess cavity was rapidly cleaned and decreased in size. The mini-thoracotomy could be closed on the 9th postoperative day. Closure of the cavity was simple, without any short- or long-term treatment failure. This technique reduced the trauma associated with the procedure. The patient was discharged on the 11th postoperative day. CONCLUSIONS Vacuum-assisted closure systems should be considered for widespread use as an alternative option for the treatment of complicated pulmonary abscess in elderly, debilitated, immunocompromised patients after failed conservative treatment.
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Affiliation(s)
- Zsolt Sziklavari
- />Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, Regensburg, 93049 Germany
| | - Michael Ried
- />Department of Thoracic Surgery, University Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053 Germany
| | - Hans-Stefan Hofmann
- />Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, Regensburg, 93049 Germany
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16
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Hofmann HS, Ried M, Sziklavari Z. Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion. J Cardiothorac Surg 2014; 9:70. [PMID: 24721196 PMCID: PMC4017962 DOI: 10.1186/1749-8090-9-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background In cases of intravenous placement failure of the left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) and obliteration of the left pleural space, the alternative approach of transthoracic placement by video-assisted thoracoscopic surgery (VATS) is difficult and not commonly practiced. Methods Here, we present a simple technique for transthoracic introduction of an epicardial LV lead using a wound retractor (ALEXIS®) in a patient with heart failure. This wound retractor enables atraumatic tissue retraction without rib spreading, an optimal direct view in the pleural space for surgical pleurolysis and a high degree of safety for the patient. Results No perioperative complications occurred. The tube drainage was removed on the second postoperative day, and the patient was discharged on the third postoperative day. Conclusions The decided advantage of this new method is the lack of any need for rib spreading using a mechanical retractor. Especially in patients with a history of open-heart surgery (including internal mammary artery bypass grafting and/or revascularisation of the left lateral wall) or known pleural adhesions (e.g., pleuritis or lung operations), the described technique provides a rapid and save access with minimal surgical effort and greater safety.
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Affiliation(s)
| | | | - Zsolt Sziklavari
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049 Regensburg, Germany.
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