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 Bronchial fistula closure with negative pressure wound therapy: a feasible and cost-effective treatment

2016 ◽  
Vol 43 (4) ◽  
pp. 292-294 ◽  
Author(s):  
RODRIGO BARBOZA NUNES ◽  
BRUNO FRANCISCO MÜLLER NETO ◽  
FEDERICO ENRIQUE GARCIA CIPRIANO ◽  
PEDRO SOLER COLTRO ◽  
JAYME ADRIANO FARINA JÚNIOR
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Cost Effective ◽  
Surgical Approaches ◽  
Negative Pressure Therapy ◽  
Wound Therapy ◽  
Cost Of Treatment ◽  
Pressure Therapy ◽  
Bronchial Fistula ◽  
Cost Effective Treatment

ABSTRACT Treatment of bronchial fistula (BF) after pulmonary lobectomy is a challenge. Often, patients require long hospital stay, have recurrent empyema and pneumonia, are susceptible to sepsis, often need broad-spectrum antibiotics, as well as various surgical approaches. With the advent and growing evidence of the benefits of negative pressure therapy (NPT), its use in some patients with BF has been reported with encouraging results concerning its feasibility and cost-effectiveness. The aim of this study was to demonstrate the application of NPT as a resource for BF treatment and comparatively analyze the overall cost of treatment.

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.

Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
O Grauhan ◽  
A Navasardyan ◽  
M Hofmann ◽  
P Müller ◽  
J Stein ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Obese Patients ◽  
Wound Infections ◽  
Wound Therapy

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

The effects and use of negative pressure wound therapy – a set of case reports

2020 ◽  
Vol 99 (4) ◽  
pp. 183-188
Keyword(s):  
Wound Healing ◽  
High Risk ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Wide Spectrum ◽  
Case Reports ◽  
Modern Medicine ◽  
Wound Therapy ◽  
Basic Set

Modern medicine offers a wide spectrum of wound healing resources for acute or chronic wounds. Negative pressure wound therapy (NPWT) is a very effective method, allowing complicated defects and wounds to heal. The basic set is usually provided with various special accessories to facilitate the use and support safe application of NPWT to high-risk tissue. Selected case reports are presented herein to document the special use and combinations of materials in negative pressure wound therapy.

Sign in / Sign up

Export Citation Format

Share Document