The Use Of Negrative Pressure Wound Therapy As Adjunct Therapy To Tube Thoracostomy In The Management Of Clinically Significant Subcutaneous Emphysema
*Jonathan A Nitz1, *Melissa G Medina1, *Randall Cabrera1, *Shannon Foiles2, Richard Anderson2
1University of Illinois College of Medicine, Peoria, IL;2Department of Thoracic Surgery, OSF Saint Francis Medical Center, Peoria, IL
Objectives: The development of subcutaneous emphysema (SCE) can be a complication after thoracic surgery leading to significant sequelae despite chest tube drainage. Multiple therapeutic techniques are described including negative pressure wound therapy (NPWT), though literature is limited. We report a case series demonstrating NPWT to aid in resolution of significant SCE.
Methods: Retrospective chart review of 16 patients who received negative pressure wound therapy for the development of significant SCE post-operatively after undergoing a thoracic procedure from April 2015 to June 2019 was performed. NPWT was used as additional therapy to an existing indwelling chest tube in our patient population. Patient demographics were recorded, and outcome measures included diagnosis, type of thoracic procedure, intra- and post-operative complications, NPWT duration and time to symptom resolution. Associated costs were also evaluated. Descriptive statistics, mean, median, standard deviation, frequency and percentages were reported.
Abstract Results: 16 patients were included in the data analysis. After NPWT was initiated, 14 patients (87.5%) had SCE resolution, 1 (6.25%) remained with persistent air leak, 1 (6.25%) patient died secondary to cardiac causes and not due to SCE. Mean hospital length of stay was 11.38 days (±6.95). Mean duration of first unit was 10.6 days (±5.8). 1 patient necessitated placement of a second unit for 13 days. Mean initial chest tube duration was 8 days (±6.1) in 14 patients. 4 patients required placement of a second chest tube with a mean duration of 12.3 days (±6.2) and 21.5 days (± 13.4) for a third chest tube in 2 patients. Abstract
Conclusions: The use of NPWT is a viable adjunct therapy to chest tube drainage treating SCE after thoracic surgery. Future comparison studies can be directed towards cost analysis, reduction in chest tube duration and symptom resolution.
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