title: Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system.
abstract: OBJECTIVE
  The conventional management of a post-pneumonectomy (PPE) and post-lobectomy empyema (PLE) necessitates an open window, wound packing, frequent wound debridement, and prolonged hospitalization. We studied the feasibility of outpatient therapy in this patient population using the vacuum-assisted closure (VAC) therapy system.
  
  
  METHODS
  From September 2005 to November 2007, six patients with PPE and PLE with or without a bronchopleural fistula underwent outpatient therapy using a VAC system. After debridement and closure of the bronchial fistula, a VAC system was applied and the patient was discharged. The patient returned for debridement under anesthesia and VAC replacement every 7-10 days. Once the pleural space was cleaned, the residual space was obliterated, and the wound was closed over suction catheters. Of the six patients, two developed recurrent infection after the closure that required repeated VAC dressings and flap closures.
  
  
  RESULTS
  The outpatient use of the VAC system in patients with PPE and PLE avoided the need for any daily painful dressing changes and significantly decreased the total length of hospitalization and the time to closure of the empyema space, and thus increased the overall patient satisfaction.
  
  
  CONCLUSIONS
  Our results suggest that outpatient VAC therapy of PPE and PLE is feasible and beneficial.
authors.affiliation: The George Washington University Medical Center, 2300 Eye Street N.W., Washington, DC 20037, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Mufarrej
authors.forename: Marc
authors.initials: M
authors.lastname: Margolis
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempesta
authors.forename: Eric
authors.initials: E
authors.lastname: Strother
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
mesh_terms: D000328:Adult; D000368:Aged; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation* / Q000379:methods; D010045:Outpatients / Q000706:statistics & numerical data; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult