A Case of Empyema after Lung Cancer Surgery Treated by Open-window Thoracostomy Followed by Negative Pressure Wound Therapy

Abstract

A 75-year-old man who had undergone right lower lobectomy for primary lung cancer (adenocarcinoma, pT1aN0M0, p-stage IA) developed pyrexia and purulent pleural effusion on the post-operative day (POD) 9. Bacterial culture of the effusion detected methicillin-resistant Staphylococcus aureus, and the patient was diagnosed with postoperative empyema and treated with chest tube drainage and antibiotic therapy. Despite these treatments, the disease was refractory, and open-window thoracostomy was carried out on POD 52. Infection control was immediately achieved, and the bacterial test turned negative by 5 days after the thoracostomy. Since closure of the empyema cavity by muscle plombage and thoracoplasty seemed difficult due to anatomical reason, negative pressure wound therapy (NPWT) was applied. To prevent lung injury caused by the negative pressure, the infill (V. A. C. ^®GranuForm^®) was covered with two-ply non-adhesive gauze, and suction was proceeded at a relatively low pressure (-50mmHg). During the NPWT, the infill was exchanged every 72 hours while evaluation of the presence of parenchymal injury or ischemia was carefully performed. Finally, complete epithelization and closure of the cavity was accomplished 100 days after the initiation of NPWT.
NPWT is a useful device that can achieve complete wound healing with very low suction and packing in a body cavity.