Intra-Pleural Vacuum Dressing: An Alternative To Open-Window Thoracostomy

Alessandro W. Mariani ¹, João Bruno R. Machado Lisboa ¹, Guilherme De Abreu Rodrigues ¹, Ester Moraes de Ávila ², Ricardo M. Terra ³, Paulo M. Pego-Fernandes ¹

¹ Thoracic Surgery Department - Heart Intitute (InCor) Hospital das Clinicas da FMUSP, São paulo, Brazil; ² Faculdade de Medicina da Universidade de São Paulo, São paulo, Brazil; ³ Thoracic Surgery Department - ICESP - FMUSP, São paulo, Brazil;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–C

Abstract

Objective: Pleural empyema is a disease of major morbidity and mortality worldwide. The stage III empyema need to be surgically treated by Pulmonary Decortication or Open-Window Thoracostomy, which is preferred for patients with bad clinical conditions because it has a lower operative risk, however, it may have a greater quality of life impact due to the necessity of the thoracic stoma which may last for years or even require additional surgery for closure. Recent studies proposed the intra-pleural use of the vacuum dressing device, placed in a minimally invasive procedure, as an alternative to classical Open-Window Thoracostomy. The objective is to analyze a case series and describe the applied technique.

Method: Case series with 3 pleural empyema patients treated with Minimally Invasive Vacuum-Assisted Closure Therapy.

Results: Case 1: S.C.F, male, 44 years old, with diagnosis of parapneumonic empyema stage III without improvement after thoracic drainage. Case 2: M.A.A, 66 years old, male, with diagnosis of parapneumonic empyema stage III without any previous surgical intervention. Case 3: M.V.S.N, 20 years old, male, empyema secondary to undertreated hemothorax. All cases were submitted to Minimally Invasive Vacuum-Assisted Closure Therapy, performed with a 5cm incision without rib retraction or resection; the dressings were changed in the 4th postoperative day and the thoracostomies were closed in the 7th PO. The measured residual cavity were reduced from 500ml to 100ml in case 1, from 300ml to 60ml in case 2 and from 200ml to 30ml in case 3. The patients discharges were: 8th PO; 11th PO and 11th PO without any surgical complications. All patients have at least 3 month follow-up without furthers events.

Conclusions: The Minimally Invasive Vacuum-Assisted Closure Therapy represents an effective and safe alternative for Open-Window Thoracostomy.