Intrathoracic application of vacuum wound therapy following thoracic surgery

The VAC system (vacuum-assisted wound closure) is an established noninvasive active therapy to promote the healing of difficult wounds that fail to heal with conventional treatment after cardiac surgery. We report our initial experience of the intrathoracic application of the VAC system after extended thoracic surgery.

Thirteen patients (11 men, 2 women) with a median age of 60 years (range 41 to 82 years) with deep wound infections after thoracotomy (empyema = 3; lobectomy = 5; Pancoast = 1; pneumonectomy = 4) were treated primarily with the VAC system after initial surgical debridement. All patients had an increased risk for impaired wound healing (e.g., diabetes, obesity, empyema, steroids). The VAC system was removed when systemic signs of infection resolved and quantitative cultures were negative.

After a mean period of 64 +/- 45 days (range 7 to 134 days) the VAC system was removed in all patients. It was used as a bridge to reconstructive surgery with a latissimus dorsi muscle flap in 2 patients (15 %), while surgical wound closure could be achieved in the remaining 11 patients (85 %). Complete healing without recurrence was achieved in 11/13 (85 %) patients to date. Hemodynamic or respiratory complications (e.g., air leakage) during VAC system application were not observed in any case. Survival was 100 % after 16 +/- 9 months. Duration of hospital stay varied from 16 to 110 days (mean 44 +/- 34 days).

Intrathoracic vacuum therapy after extended thoracic surgery seems to be an effective and safe adjunct to conventional treatment modalities for the therapy of intrathoracic infections or deep wound infections.