title: Management of pleural empyema with a vacuum-assisted closure device and reconstruction of open thoracic window in a patient with liver cirrhosis.
abstract: The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.
authors: Servicio de Cirugía Torácica, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, D.F., México. Electronic address: munguia.cirujano@gmail.com.
authors: Daniel Alejandro
authors: DA
authors: Munguía-Canales
authors: Gary Kosai
authors: GK
authors: Vargas-Mendoza
authors: Gustavo
authors: G
authors: Alvarez-Bestoff
authors: Moisés Cutiel
authors: MC
authors: Calderón-Abbo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017577:Cutaneous Fistula / Q000209:etiology; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D010996:Pleural Effusion / Q000209:etiology; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D019736:Prostheses and Implants; D001261:Pulmonary Atelectasis / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012272:Ribs / Q000382:microbiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D041162:Staphylococcus haemolyticus / Q000302:isolation & purification*; D035441:Thoracic Wall / Q000601:surgery*; D014797:Vital Capacity; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cirrosis hepática; Empiema pleural; Liver cirrhosis; Pleural empyema; Sistema cerrado de succión; Vacuum-assisted closure device