Open window thoracostomy: a new therapeutic option using topical negative pressure wound therapy

Open window thoracostomy (OWT) is an invasive treatment option for thoracic empyema that is seldom indicated. These wounds are accompanied with a prolonged hospital stay and significant patient discomfort over an extended period of time. A retrospective report was conducted on patients who underwent OWT at the Academic Medical Center (Amsterdam, The Netherlands) and evaluated if topical negative pressure therapy ([TNP], V.A.C.® Therapy™, KCI Medical BV, Houten, The Netherlands) is a valid treatment option for these wounds. Clinical outcome and applied management methods are analyzed. Between January 1986 and June 2005, 15 patients, with a mean age of 54 years, were treated with OWT. Recently, the authors have used TNP in combination with OWT as a new treatment modality to obtain rapid control over pleural bacterial load and to achieve a well-vascularized wound surface. Good clinical results and a trend toward shorter hospital stays and improved quality of life were seen. Open window thoracostomy as a treatment modality for thoracic empyema is a valid option but only when other means fail or are contraindicated. Treatment of open window thoracostomy in combination with TNP is a safe and adequate therapeutic option for thoracic empyema resulting in improved quality of life and overall shorter hospital stay.