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Ann Thorac Surg 2005;79:1196-1200
© 2005 The Society of Thoracic Surgeons
a Department of Thoracic and Vascular Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
b Department of Surgical Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
c Department of Wound Healing and Metabolism, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
d Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
Accepted for publication September 21, 2004.
* Address reprint requests to Dr O'Connor, Thoracic and Vascular Surgery, R. Adams Cowley Shock Trauma Center, 22 S Greene Street, Baltimore, MD 21201 (E-mail: joconnor{at}umm.edu).
BACKGROUND: Destruction of chest wall musculature from trauma, empyema, or local infection limits closure options, especially with muscle flaps. While the vacuum-assisted closure system (VAC; KCI International, San Antonio, TX) has been used for wounds in other anatomic locations, we have found no series for chest wounds.
METHODS: This is a retrospective review of trauma registry data from the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine from 2000 to 2003.
RESULTS: Seventeen patients were identified and divided into two groups. Group I consisted of seven patients with primary chest wall processes: four necrotizing soft-tissue infections and three with thoracic trauma resulting in significant loss of chest wall musculature. Group II consisted of ten patients with empyema and varying levels of chest wall extension. Six were postpneumonic and four postoperative. Wound size averaged 16 x 7 cm (range, 7 x 3 cm to 21 x 11 cm). The VAC duration averaged nine days (range, 3 to 21 days) and changed every two to three days. Fourteen wounds were culture positive; nine staphylococcus aureus, two alpha hemolytic streptococcus, and one each with enterococcus, Citrobacter, and anaerobes. Eight were polymicrobial. There were no deaths. All wounds healed without rotational muscle flaps. Ten underwent delayed primary closure, four split-thickness skin graft, and three healed by secondary intention. There was one significant complication: a wound infection after delayed primary closure which required reoperation.
CONCLUSIONS: Closure of complex chest wall wounds can present significant technical challenges. The VAC system is a simple, useful, and novel alternative to conventional wound care even with large, infected wounds.
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