Open Window Thoracostomy
Open Window Thoracostomy
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.
Thoracic empyema (TE) remains a surgical challenge and is associated with substantial morbidity and mortality. In more than 50% of patients, TE is of parapneumonic origin. After pneumonectomy TE occurs in 2%-15% of patients. Although more uncommon, it may complicate any kind of pulmonary resection. Mortality rates of up to 70% have been reported. The presence of a bronchopleural fistula increases the morbidity and mortality of TE by providing a source of continuous contamination of the pleural space and by promoting aspiration of infected pleural fluid into pulmonary tissues.
Management consists of early, adequate drainage. Closed thoracostomyand conversion to open surgical drainage followed either by a large-bore tube drainage or open window thoracostomy (OWT), are procedures that can be continued for an extended period to control infection, obliterate loculations, and heal pleural surfaces by second intent. In spite of their good results and advantages, drainage, irrigation, and other promising techniques (eg, video-assisted thoracoscopic surgery (VATS), have their limitations in treating TE. They are likely to be successful in early stages. When these more conservative measures fail, a more aggressive surgical approach is indicated (eg, OWT). If the condition of the patient precludes major surgery such as surgical decortication,OWT can serve as a more valid option to control TE. Although OWT is an invasive approach with a prolonged hospital stay and major patient discomfort over a long period of time, OWT remains a therapeutic option in patients with TE.
Topical negative pressure therapy (TNP) has gained wide acceptance in many surgical disciplines. Topical negative pressure therapy is a closed system that applies subatmospheric pressure to wound tissue through polyurethane foam. Beneficial effects on blood flow to the wound and proliferation of granulation tissue have been reported. The mechanism entails the removal of interstitial edema lowering capillary afterload and thereby promoting microcirculation. Also, by removing excess fluid, mitosis inhibitory factors are diminished and bacterial loads are reduced. By applying vacuum,wound edges are approximated thus reducing wound size.
A retrospective analysis of patients treated with OWT in the authors' hospital was performed and TNP was evaluated as a treatment option in these wounds.
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.
Thoracic empyema (TE) remains a surgical challenge and is associated with substantial morbidity and mortality. In more than 50% of patients, TE is of parapneumonic origin. After pneumonectomy TE occurs in 2%-15% of patients. Although more uncommon, it may complicate any kind of pulmonary resection. Mortality rates of up to 70% have been reported. The presence of a bronchopleural fistula increases the morbidity and mortality of TE by providing a source of continuous contamination of the pleural space and by promoting aspiration of infected pleural fluid into pulmonary tissues.
Management consists of early, adequate drainage. Closed thoracostomyand conversion to open surgical drainage followed either by a large-bore tube drainage or open window thoracostomy (OWT), are procedures that can be continued for an extended period to control infection, obliterate loculations, and heal pleural surfaces by second intent. In spite of their good results and advantages, drainage, irrigation, and other promising techniques (eg, video-assisted thoracoscopic surgery (VATS), have their limitations in treating TE. They are likely to be successful in early stages. When these more conservative measures fail, a more aggressive surgical approach is indicated (eg, OWT). If the condition of the patient precludes major surgery such as surgical decortication,OWT can serve as a more valid option to control TE. Although OWT is an invasive approach with a prolonged hospital stay and major patient discomfort over a long period of time, OWT remains a therapeutic option in patients with TE.
Topical negative pressure therapy (TNP) has gained wide acceptance in many surgical disciplines. Topical negative pressure therapy is a closed system that applies subatmospheric pressure to wound tissue through polyurethane foam. Beneficial effects on blood flow to the wound and proliferation of granulation tissue have been reported. The mechanism entails the removal of interstitial edema lowering capillary afterload and thereby promoting microcirculation. Also, by removing excess fluid, mitosis inhibitory factors are diminished and bacterial loads are reduced. By applying vacuum,wound edges are approximated thus reducing wound size.
A retrospective analysis of patients treated with OWT in the authors' hospital was performed and TNP was evaluated as a treatment option in these wounds.
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