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Updated: May 28, 2026
03:22
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Complex pleural empyema can be safely treated with vacuum-assisted closure
Zsolt Sziklavari1, Christian Grosser, Reiner Neu
1Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstrasse 86, 93049 Regensburg, Germany. zsolt.sziklavari@barmherzige-regensburg.de
Journal of Cardiothoracic Surgery
|October 8, 2011
Summary
Vacuum-assisted closure (VAC) therapy effectively treats complex pleural empyema after open window thoracostomy (OWT). This method is safe, even with bronchial stump insufficiency or residual lung tissue, promoting healing and sepsis control.
Area of Science:
- Thoracic Surgery
- Wound Management
- Infectious Diseases
Background:
- Open window thoracostomy (OWT) is crucial for managing postoperative pleural empyema and preventing sepsis.
- Vacuum-assisted closure (VAC) is a recognized wound treatment, but its intrathoracic application for complex empyema remains under-investigated.
Purpose of the Study:
- To evaluate the efficacy and safety of intrathoracic vacuum-assisted closure (VAC) therapy in patients with pleural empyema.
- To assess VAC therapy's role in managing empyema complicated by bronchial stump insufficiency or residual lung.
Main Methods:
- Eight patients with postoperative or recurrent pleural empyema underwent OWT with VAC therapy.
- Two patients had co-existing bronchial stump insufficiency (BPF).
- Continuous suction up to 125 mm Hg was applied.
Main Results:
- VAC therapy achieved local empyema control and sepsis management.
- It facilitated wound and thoracic cavity cleaning, promoting rapid healing.
- Stable vacuum was achieved in BPF patients; smaller fistulas closed spontaneously.
- No air leaks or bleeding occurred from direct sponge contact.
- Better lung re-expansion was observed.
- Five of seven patients achieved chest wall closure after a mean of three months.
Conclusions:
- Intrathoracic VAC therapy is an effective and safe treatment for complicated pleural empyema.
- Smaller bronchial stump fistulas and residual lung tissue are not contraindications for VAC therapy.
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