title: Minimally invasive vacuum-assisted closure therapy in the management of complex pleural empyema.
abstract: OBJECTIVE
  The pool of potential candidates for pleural empyema is expanding. In a previous technical report, we tested the feasibility of the minimally invasive insertion of a vacuum-assisted closure (Mini-VAC) system without the insertion of an open-window thoracostomy (OWT). In this study, we describe a consecutive case series of complex pleural empyemas that were managed by this Mini-VAC therapy.
  
  
  METHODS
  In this retrospective study, we investigated 6 patients with multimorbidity (Karnofsky index ≤ 50%) who were consecutively treated with Mini-VAC for a primary, postoperative or recurrent pleural empyema between January 2011 and February 2012.
  
  
  RESULTS
  Local control of the infection and control of sepsis were satisfactory in all 6 of the patients treated by Mini-VAC therapy. The suction used did not create any air leaks or bleeding from the lung or mediastinal structures. Mini-VAC therapy allowed a reduction of the empyema cavity and improved the re-expansion of the residual lung. Mini-VAC therapy resulted in a rapid eradication of the empyema. The chest wall was closed in all patients during the first hospital stay. All patients left the hospital in good health (Karnofsky index >70%) and with a non-infected pleural cavity at a mean of 22 ± 11 days after Mini-VAC installation. Pleural empyema was not detected in any of the 6 patients at the 3-month follow-up appointment.
  
  
  CONCLUSIONS
  The Mini-VAC procedure with the abdication of an OWT offers a rapid treatment for complex pleural empyema with minimal surgical effort and the opportunity for a primary closure of the empyema cavity.
authors.affiliation: Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Sziklavari
authors.forename: Christian
authors.initials: C
authors.lastname: Grosser
authors.forename: Reiner
authors.initials: R
authors.lastname: Neu
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schemm
authors.forename: Tamas
authors.initials: T
authors.lastname: Szöke
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D016724:Empyema, Pleural / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Empyema; Minimally invasive surgery; VAC therapy; Wound closure
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