scholarly journals Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Caitlin J. Cain ◽  
Marc Margolis ◽  
John F. Lazar ◽  
Hayley Henderson ◽  
Margaret Hamm ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bronchopleural Fistula ◽  
Retrospective Chart Review ◽  
Fibrinolytic Therapy ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Trapped Lung ◽  
Poor Outcomes

Abstract Background Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. Methods A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. Results Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1–6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.

scholarly journals Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

2021 ◽  
Author(s):  
Caitlin J. Cain ◽  
Marc Margolis ◽  
John F. Lazar ◽  
Hayley R. Henderson ◽  
Margaret E. Hamm ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bronchopleural Fistula ◽  
Retrospective Chart Review ◽  
Fibrinolytic Therapy ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Open Window ◽  
Open Window Thoracostomy ◽  
Trapped Lung

Abstract Background: Open window thoracostomy is indicated for patients with bronchopleural fistulae or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of open window thoracostomy in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy.Methods: A retrospective chart review of all patients who underwent open window thoracostomy at a single institution from 2010-2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for open window thoracostomy.Results: Eighteen patients were identified for the study. The most common indication for open window thoracostomy was post-resectional bronchopleural fistula (n=8). Patient comorbidities were quantified with the Charleston Comorbidity index (n=11 score≥5, 10-year survival ≤21%). Three (16.7%) patients died <30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.6 ± 1.2 (range 1-6). Patients were managed with negative pressure wound therapy (n=9) or Kerlix packing (n=9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions: Our study illustrates the significant comorbidities of patients undergoing open window thoracostomy, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however open window thoracostomy procedures continue to be extremely morbid.

Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

2021 ◽  
Vol 23 (3) ◽  
pp. 157-164
Author(s):  
Valery V. Semenov ◽  
Sofya А. Prudyeva ◽  
Alexander A. Kurygin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Early Postoperative Period ◽  
Diagnosis And Treatment ◽  
Wound Therapy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

scholarly journals Conference Proceedings of the Third International Vivano Conference held from 19th – 21st March 2014 in Nuremberg, Germany

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Vivano Conference
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Cost Benefit ◽  
Wound Therapy ◽  
Fourth Degree ◽  
Surgical Interventions ◽  
The Third ◽  
Cost Benefit Ratio ◽  
The Cost

During a two-day conference international speakers presented their experiences with negative pressure wound therapy in chronic wounds but also in cases of third- and fourth-degree burns, in complex surgical interventions of the abdominal region, in open fractures as well as in thoracic and cardiac surgery. The this year’s conference focused on questions whether negative pressure wound therapy (NPWT) resulted in wound healing more often and more quickly than standard wound therapy, for which indications can NPWT be used and how should the cost-benefit ratio be evaluated.

Negative Pressure Wound Therapy (Wound VAC) in the Treatment of Chylous Fistula After Neck Dissection

2019 ◽  
Vol 128 (6) ◽  
pp. 569-574 ◽  
Author(s):  
Ashley Dorneden ◽  
Garth Olson ◽  
Nathan Boyd
Keyword(s):  
Neck Dissection ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Neck Surgery ◽  
Wound Therapy ◽  
Hospital Stays ◽  
Chylous Fistula ◽  
Complex Wounds

Objectives: Cervical chylous fistula is an uncommon but potentially severe occurrence associated with neck surgery. Methods for treating this problem have inconsistent efficacy and may result in lengthy hospital stays. Negative pressure wound therapy (NPWT) is a highly effective tool in the management of complex wounds. We report 3 cases where NPWT was successfully used to treat chylous fistulas following neck dissection. Methods: This is a retrospective chart review of 3 patients who developed chylous fistulas after neck dissection and were successfully treated with NPWT. Results: Chylous ouput ceased within 2 to 8 days of proper wound VAC placement. Hospital stays ranged from 6 to 47 days. Patients received altered diets, including TPN for 1 patient with high-flow output and nil-per-os (NPO) or clear liquids for the others. Patients received octreotide throughout their hospitalization. Conclusion: NPWT shows potential as a treatment option for both high-volume and low-volume chylous fistulas following neck dissection.

scholarly journals Initial Experience Combining Negative Pressure Wound Therapy with Autologous Skin Cell Suspension and Meshed Autografts

2021 ◽  
Author(s):  
Bonnie C Carney ◽  
Laura S Johnson ◽  
Jeffrey W Shupp ◽  
Taryn E Travis
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Chart Review ◽  
Negative Pressure Wound Therapy ◽  
Retrospective Chart Review ◽  
Initial Experience ◽  
Wound Therapy ◽  
Skin Cell ◽  
Definitive Operation ◽  
Thickness Skin

Abstract The success of autologous split-thickness skin grafts (STSGs) in the treatment of full thickness burns is often dependent on the dressing used to secure it. Tie-over bolsters have been used traditionally, however, they can be uncomfortable for patients and preclude grafting large areas in one definitive operation. Negative pressure wound therapy (NPWT) is used as an alternative to bolster dressings and may afford additional wound healing benefits. In our center, NPWT has become the dressing of choice for securing STSGs. While the RECELL® system is being used in conjunction with STSGs, it is currently unknown whether autologous skin cell suspensions (ASCS) can be used with NPWT. This report is a retrospective chart review of 9 patients treated in this manner. All wounds were almost completely re-epithelialized within 14 days, and their healing was as expected. Wound healing trajectories are shown. There were no significant complications in these patients. This dressing technique can be considered as an option when using ASCS and widely-meshed STSG.

scholarly journals Negative-pressure wound therapy in combination with bronchial occlusion to treat bronchopleural fistula: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masashi Iwasaki ◽  
Masanori Shimomura ◽  
Tsunehiro Ii
Keyword(s):  
Lung Cancer ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bronchopleural Fistula ◽  
Lung Cancer Surgery ◽  
Early Recovery ◽  
Wound Therapy ◽  
Bronchial Fistula ◽  
Lower Lobectomy ◽  
Right Lower Lobectomy

Abstract Background Bronchopleural fistula, which usually accompanies bronchial fistula and empyema, is a severe complication of lung cancer surgery. Negative-pressure wound therapy can enhance drainage and reduce the empyema cavity, potentially leading to early recovery. This therapy is not currently indicated for bronchopleural fistulas because of the risk of insufficient respiration due to air loss from the fistula. Case presentation A 73-year-old man, who was malnourished because of peritoneal dialysis, was referred to our hospital for the treatment of lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed via posterolateral thoracotomy, and the bronchial stump was covered with the intercostal muscle flap. His postoperative course was uneventful and he was discharged. However, he was readmitted to our hospital because of respiratory failure and diagnosed as having bronchopleural fistula on the basis of the bronchoscopic finding of a 10-mm hole at the membranous portion of the inlet of the remnant lower lobe bronchus. Thus, thoracotomy debridement and open window thoracostomy were immediately performed. After achieving infection control, bronchial occlusion was performed using fibrin glue and a polyglycolic acid sheet was inserted through a fenestrated wound. Bronchial fistula closure was observed on bronchoscopy; therefore, a negative-pressure wound therapy system was applied to close the fenestrated wound. The collapsed lung was re-expanded and the granulation tissue around the wound increased; therefore, thoracic cavity size decreased and thoracoplasty using the latissimus dorsi was performed. Conclusions This bronchopleural fistula was treated successfully after a right lower lobectomy using an extra-pleural bronchial occlusion and negative-pressure wound therapy.

scholarly journals Delayed Closure of Open Abdomen in Septic Patients Treated With Negative Pressure Vacuum Therapy and Dynamic Sutures: A 10-Years Follow-Up on Long-Term Complications

2021 ◽  
Vol 7 ◽  
Author(s):  
Anna Theresa Hofmann ◽  
Christopher May ◽  
Karl Glaser ◽  
René H. Fortelny
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Fascial Closure ◽  
Wound Therapy ◽  
Surgical Interventions ◽  
Incisional Hernias ◽  
Operating Field

Introduction: Patients with open abdomen after surgical interventions associated with the complication of secondary peritonitis are successfully treated with negative pressure wound therapy. The use of dynamic fascial sutures reduces fascial lateralization and increases successful delayed fascial closure after open abdomen treatment.Methods: In 2017 we published the follow-up results of 38 survivors out of 87 open abdomen patients treated with negative pressure wound therapy and dynamic fascial sutures between 2007 and 2012. In our current study we present the 10-years follow-up results regarding long-term complications with the focus on incisional hernias and pain. Since 2017 seven more patients have died, hence 31 patients were included in the current study. The patients were asked to answer questions about specific long-term complications of OA treatment including pain, the presence of incisional hernias and subsequent surgical interventions. Demographic data and data regarding fascial closure after open abdomen treatment were collected. All results were analyzed quantitatively. The follow-up period was 8–13 years.Results: The median age was 69 (30–90) years, and 15 (48.4%) were females. Twenty-four patients (77.4%) responded to the questionnaire: Three patients (12.5%) suffered from pain in the original operating field, all three at rest but not during exercise. None of the patients required analgesic treatment. Eleven patients (45.8%) were found to have incisional hernias. Five out of 11 hernias (45.5%) were treated by surgery and did not declare any pain in the operating field. Among the patients with incisional hernias lower MPI (Mannheimer Peritonitis Index) at the time of primary surgery but more reoperations and treatment days were found. The technique of fascial closure was heterogenic and no differences in the occurrence of incisional hernia could be detected.Conclusion: The incidence of incisional hernias after open abdomen treatment is still high, but are associated with little pain in the original operating field. Further studies are required to investigate methods for fascial closure techniques after OA treatment.

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