Introduction

Traditionally, flaps have been used for the occupation of dead space in the pleural cavity with complex thoracic wounds. This practice entails the morbidity of a donor site and, in certain instances, may not be possible. Use of the wound VAC has been described for the treatment of defects of the thoracic wall, but intrapleural use has not been described for the treatment of thoracic dead space. For patients in whom flap reconstruction is not a possibility, intrapleural placement of the wound VAC represents a new method of treatment.

Methods and Materials

Three patients with extensive chest wall infections following thoracotomy underwent multiple debridements of the thoracic wall which precluded the use of a local flap for the resultant intrapleural dead space. The patients' profound physiologic compromise made them poor candidates for free tissue transfer reconstructions. These patients were treated by placement of the VAC sponge within the thoracic cavity for the occupation and eventual obliteration of dead space.

Results

All three patients lived, tolerated the treatment with the VAC, and went on to heal their wounds without requiring further surgery. None developed a bronchopleural fistula, and follow-up CT scans demonstrate the absence of remaining dead space in the thoracic cavity.

Conclusion

Intrapleural placement represents a new application of the VAC in thoracic reconstruction. The use of the VAC accomplished the goal of obliterating pleural dead space without the need for flap transfer in these patients. While this application of the wound VAC was effective in this series and has the potential to be of great benefit in thoracic reconstruction, larger numbers of patients are needed to fully assess the long term efficacy and safety of this promising treatment method.