| Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie | ||||
| Publisher: | GEORG THIEME VERLAG KG | ||||
| Place of Publication: | STUTTGART | ||||
| Volume: | 140 | ||||
| Number of Issue or Book Chapter: | 03 | ||||
| Page Range: | pp. 321-327 | ||||
| Date: | 2015 | ||||
| Institutions: | Medicine > Abteilung für Thoraxchirurgie | ||||
| Identification Number: |
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| Keywords: | OPEN-WINDOW THORACOSTOMY; PRESSURE WOUND THERAPY; POSTPNEUMONECTOMY EMPYEMA; THORACIC-SURGERY; LONG-TERM; MANAGEMENT; TRANSPOSITION; OPERATION; vacuum-assisted closure; VAC; pleural empyema; lung abscess; Mini-VAC; Mini-VAC-Instill | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 60357 |
Web of ScienceAbstract
Background: Complex pleural empyema or lung abscesses are either characterised by long-standing treatment (including treatment failure) or by a bad general condition of the patient (multiple morbidity, sepsis). The operative rectification is often associated with increased morbidity and mortality rates in these cases. Traditionally, the therapeutic tendency for such patients was towards primary ...
Abstract
Background: Complex pleural empyema or lung abscesses are either characterised by long-standing treatment (including treatment failure) or by a bad general condition of the patient (multiple morbidity, sepsis). The operative rectification is often associated with increased morbidity and mortality rates in these cases. Traditionally, the therapeutic tendency for such patients was towards primary creation of a thoracic window including open wound treatment, but this was always also associated with a long sickness and restrictions in the quality of life. The intrathoracic vacuum treatment (VAC) offers here entirely new options in the treatment of complicated pleural empyema and lung abscesses. Method: We present an illustration of our own clinical experience associated with a selective literature research via Medline (keywords: VAC, vacuum-assisted closure, thoracic empyema). Results: After the initial successes of the extra-thoracic application of the VAC treatment, the procedure was also analysed for its intrathoracic/pleural use to treat pleural empyema and lung abscesses with and without bronchus stump insufficiency. Initially, the use of the intrathoracic VAC treatment was carried out via a thoracic window (with rib resection), later we developed a minimally invasive procedure (Mini-VAC) while relieving the osseous thorax. An additional intrapleural rinsing with antiseptics (Mini-VAC-Instill) is very practical in cases of proven germ populations. The benefits of the Mini-Vac/Mini-VAC-Instill are: immediate secretion suction with quick local cleaning, rapid germ eradication with a small risk of a fresh population, improvement of the expansion behaviour of the lung as well as short treatment times with quick reclosure of the thorax. In addition to many retrospective examinations, there has so far only been one cohort study in which the classic thoracic window was compared with the VAC treatment. The duration of the stomatic situation as well as the long-term survival in the VAC group were better here than those in the non-VAC group. Conclusion: The intrathoracic VAC treatment (Mini-Vac/Mini-VAC-Instill) is an innovative procedure that promotes wound cleaning and wound healing in complicated pleural empyema and lung abscesses. Due to the benefits of this procedure, including the improvement of the patient ' s comfort and the quality of life, the procedure has seen a rapid and broad clinical acceptance.
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