Vakuumtherapie beim Pleuraempyem - Erste Erfahrungen mit der Anwendung im Pleuraspalt

Abstract

Meanwhile vacuum-assisted closure (V.A.C.®) therapy belongs to the standard procedures in cardiovascular surgery. Its intrathoracal application is mentioned in one unique case-report in literature. We like to show our first experiences with this technique demonstrating three cases with pleural infection. One patient with bronchial stump insufficiency, one with pleural empyema and one with penetrating abscess of the chest was treated with V.A.C.®-therapy. We applied a combination of microporous silicon fleece and polyurethan foam in direct neighbourhood to ventilated lung areas inside the thoracic cavity. One patient died of metastasis of his cancer disease, while wound situation and bronchial stump insufficiency could be treated well. Two patients could be treated succesfully and be discharged out of the hospital. No complications due to V.A.C.®-therapy could be seen, such as fistulas of the lung or bleeding of the mediastinal organs. Intrathoracal V.A-C.®-therapy can be performed as a good therapeutic option in the treatment of septic diseases inside the chest.

Schlüsselwörter

Vakuumtherapie - Thoraxchirurgie - Pleuraempyem

Key words

vacuum-assisted closure - thoracic surgery - pleural empyema

Literatur

• 1 Kutschka I, Frauendorfer P, Harringer W. [Vacuum assisted closure therapy improves early postoperative lung function in patients with large sternal wounds].  Zentralbl Chir. 2004;  129 (Suppl 1) S33-S34
• 2 Gustafsson R I, Sjogren J, Ingemansson R. Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy.  Ann Thorac Surg. 2003;  76 2048-2053
• 3 Clubley L, Harper L. Using negative pressure therapy for healing of a sternal wound.  Nurs Times. 2005;  101 44-46
• 4 Wackenfors A, Gustafsson R, Sjogren J, Algotsson L, Ingemansson R, Malmsjo M. Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy.  Ann Thorac Surg. 2005;  79 1724-1730
• 5 O'Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds.  Ann Thorac Surg. 2005;  79 1196-1200
• 6 Scholl L, Chang E, Reitz B, Chang J. Sternal osteomyelitis: use of vacuum-assisted closure device as an adjunct to definitive closure with sternectomy and muscle flap reconstruction.  J Card Surg. 2004;  19 453-461
• 7 Fleck T, Moidl R, Giovanoli P, Wolner E, Grabenwoger M. [Early treatment of sternal wound infections with vacuum assisted closure therapy reduces involvement of the mediastinum and further diminishes the need of plastic reconstructive surgery].  Zentralbl Chir. 2004;  129 (Suppl 1) S35-S37
• 8 Gustafsson R I, Sjogren J, Ingemansson R. Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy.  Ann Thorac Surg. 2003;  76 2048-2053
• 9 Song D H, Wu L C, Lohman R F, Gottlieb L J, Franczyk M. Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement and definitive closure.  Plast Reconstr Surg. 2003;  111 92-97
• 10 Ramnarine I R, McLean A, Pollock J C. Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis.  Eur J Cardiothorac Surg. 2002;  22 1029-1031
• 11 Fleck T M, Fleck M, Moidl R, Czerny M, Koller R, Giovanoli P, Hiesmayer M J, Zimpfer D, Wolner E, Grabenwoger M. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery.  Ann Thorac Surg. 2002;  74 1596-1600
• 12 Tang A T, Okri S K, Haw M P. Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery.  J Wound Care. 2000;  9 229-230
• 13 Ditterich D, Rexer M, Rupprecht H. [Vacuum assisted wound closure technique in bronchial stump dehiscence after lobectomy-a case report from thoracic surgery].  Zentralbl Chir. 2004;  129 (Suppl 1) S137