title: [V. A. C. INSTILL® therapy - new option in septic thoracic surgery].
abstract: BACKGROUND
  The V. A. C. INSTILL® therapy is an innovative process for treating chronic wounds that are not optimally accessible to a systemic antibiotic therapy or infected with multi-resistant pathogens. We report on our first experience and applications of V. A. C. INSTILL® therapy in the field of septic thoracic surgery.
  
  
  METHODS
  V. A. C. INSTILL therapy was used in 11 cases between 11/2009 and 01/2012. Three patients had sternum osteomyelitis (2 MRSA, 1 Finegoldia magna). In 3 patients chronic pleural empyema after lobectomy (1 Streptococcus viridans, 1 mixed infection with MRSA among others) and after pneumectomy (1 MRSA) were detected. In 2 cases there was an acute pleural empyema with extensive phlegmona in the region of the thoracic soft tissues (2 streptococci). In 1 patient a chronic pleural empyema with MRSA infection was treated. Septic arthritis of the sternoclavicular joint with joint destruction and extensive phlegmona in the region of the cervical soft tissues (1 Streptococcus pneumoniae, 1 Staphylococcus aureus) was treated in 2 patients. In all cases instillation of the wound was performed with Lavasept 0.2 %. Swabs of the wound were taken before starting and after ending V. A. C. INSTILL® therapy as well as before wound closure.
  
  
  RESULTS
  Mean patient age was 48.8 ± 18.9 years. V. A. C. INSTILL® therapy was performed for 6.5 ± 1.7 days. Instillation time amounted to 21.7 ± 5.7 s. The duration of action was standardised at 18 min in all cases. In 2 cases (1 MESA, 1 finegoldia) the V. A. C. INSTILL® therapy was repeated. In 10 patients a sterile wound status was achieved before secondary wound closure. All wounds underwent secondary closure without recurrence.
  
  
  CONCLUSIONS
  Chronic osteomyelitis with MRSA infections as well as chronically infected residual cavities after empyema surgery and extensive phlegmona are possible indications for V. A. C. INSTILL® therapy in order to help eradicating the infection as quickly and as completely as possible.
authors: Thoraxchirurgische Abteilung in der Chirurgischen Klinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Deutschland. waldemar.schreiner@uk-erlangen.de
authors: W
authors: W
authors: Schreiner
authors: O
authors: O
authors: Oster
authors: P
authors: P
authors: Stapel
authors: H
authors: H
authors: Sirbu
mesh_terms: D001170:Arthritis, Infectious / Q000601:surgery; D001424:Bacterial Infections / Q000601:surgery*; D002481:Cellulitis / Q000601:surgery; D002908:Chronic Disease; D024901:Drug Resistance, Multiple, Bacterial; D016724:Empyema, Pleural / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000601:surgery; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation*; D010462:Peptostreptococcus; D011008:Pneumococcal Infections / Q000601:surgery; D011013:Pneumonectomy; D012086:Reoperation; D013203:Staphylococcal Infections / Q000601:surgery; D013247:Sternoclavicular Joint; D056346:Sternotomy; D013290:Streptococcal Infections / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery*; D013896:Thoracic Diseases / Q000601:surgery*; D034363:Viridans Streptococci; D014945:Wound Healing / Q000502:physiology; D014946:Wound Infection / Q000601:surgery*