EWS and vacuum-assisted closure (VAC) therapy for the early closure of open-window thoracostomy in the treatment of pleural empyema with a fistula

Abstract

Intractable empyema with a bronchial fistula is often only treatable by long-term fenestration. We report a case with a good prognosis using bronchial occlusion and vacuum-assisted closure after open-window thoracostomy without surgical closure. A 62-year-old man was admitted to another hospital for a cough and fever. He received antibiotic treatment and drainage for a pulmonary abscess of the middle lobe and empyema. He was referred to our hospital for surgical treatment for his thoracic empyema with a bronchopleural fistula. First, open-window thoracostomy was performed. For postoperative leakage, we performed bronchial occlusion using an Endobronchial Watanabe Spigot^® (EWS). For the closure of the open-window cavity, vacuum-assisted closure (VAC) was applied. Six months postoperatively, complete closure of the wound was confirmed without thoracoplasty.