[Vacuum bandage in the treatment of pleural empyema after pneumonectomy].

Abstract

Objective: To improve the treatment of patients with postoperative pleural empyema without fistula of the main bronchus through staged debridement of postpneumonectomy pleural cavity using vacuum-assisted dressing for relief of symptoms in acute period of empyema and earlier reconstructive treatment.

Material and methods: About 60 pneumonectomies for cancer and 15 pneumonectomies for purulent-necrotic lung diseases are performed annually in the thoracic surgical center. Over 350 pneumonectomies were performed between 2018 and 2023. Of these, there were 70 interventions for purulent-inflammatory lung diseases (including pulmonary gangrene). The incidence of complications within postoperative thoracotomy is 1.2%, pleural cavity (pleural empyema and early fragmentation of pleural cavity) - 0.9%. A combination of postoperative thoracotomy suppuration with pleural empyema is an even rarer complication (0.8%). We compared 2 groups of patients who were treated at different periods for postpneumonectomy pleural empyema without fistula of the main bronchus. The 1^st group included 11 patients (6 men and 5 women) who received treatment between 2006 and 2011 (thoracostomy using ointment dressings and multiple daily dressings (sometimes up to 4 times a day) under antibacterial therapy). Such approach required daily multiple dressings at the exudation stage. Wound healing and granulation required much time that caused discomfort to the patient and reduced quality of life. In 10 out of 11 patients in this group, the complication developed after surgery for lung gangrene. After surgery, one patient died from multiple organ failure following pneumonia of a single lung and severe sepsis. Mean length of hospital-stay was 40±3 days. The 2^nd group (2011-2023) included 9 patients (5 men and 4 women). Vacuum-assisted dressings were used. In 8 patients, this complication developed after surgery for lung gangrene. There were no fatal outcomes. Mean length of hospital-stay was 16±2 days.

Results: Vacuum-assisted dressing reduced the risk of fatal erosive bleeding and the number of dressings, as well as provided certain comfort and mobility of the patient. The need for bone resections for chronic osteomyelitis was 0.1% vs. 40% in case of ointment dressings. In addition, two clinical cases of vacuum dressings combined with cell therapy for prevention of complications after pneumonectomy for pulmonary gangrene were considered. Good clinical results were obtained.

Conclusion: Vacuum-assisted dressing for postpneumonectomy pleural empyema without fistula of the main bronchus reduces duration of wound healing phases and hospital-stay. Prophylactic vacuum-assisted dressings after pneumonectomy for purulent-inflammatory lung diseases excluded empyema of postpneumonectomy cavity and improved tissue healing.