An alternative method of closure of open window thoracostomy: a two-staged approach

Refractory empyema poses significant treatment challenges, but open window thoracostomy (OWT) remains an effective solution, facilitating infection control and promoting recovery. However, after the resolution of infection, patients often face complications due to the open pleural cavity and residual pleural space. The closure of open window thoracostomies is particularly difficult, especially in the presence of large residual spaces and bronchopleural fistulas (BPFs). This case series examines six patients who underwent OWT for empyema of various etiologies, employing a two-stage approach: intra-thoracic vacuum therapy followed by closure of the residual pleural space with a pedicled muscle flap. The outcomes demonstrate the feasibility and effectiveness of this technique in addressing complex OWT closure challenges and improving patient outcomes.