A Case of Empyema with Fistula due to Nontubuerculous Mycobacteriosis Treated with EWS and Vacuum-assisted-closure (VAC) Therapy

Acute Pleural Empyema Secondary to COVID-19 Treated with Negative-Pressure Wound Therapy, Resulting in Good Lung Expansion and Early Wound Closure

“…According to previous reports, the application of NPWT for pleural empyema has some concerns. While wounds wherein major organs are exposed are contraindicated, there are several reports with no complications, even when the foam was in direct contact with the pulmonary tissue 6,[8][9][10] . Conversely, one study reported that direct contact of the foam with the chest wall resulted in discontinuation of the procedure due to chest pain, or adhesions to the apex that required safe removal with video-assisted thoracic surgery (VATS) 11) .…”

“…Although the presence of a BPF is also contraindicated, effective NPWT is possible if negative pressure is successfully applied, and there have been reports that small BPFs close spontaneously while performing NPWT 9,14) . Conversely, large BPFs do not close spontaneously 9) ; nevertheless, effective NPWT with bronchial filling by endobronchial Watanabe spigot (EWS) 10,[15][16][17][18] or tracheal stenting 14) has been reported. There is also a report of NPWT with a BPF covered by silvercontaining carboxymethylated cellulose in a patient with residual air leakage after bronchial filling with EWS 19) , and another of one-stage initiation of NPWT after pedicled muscle flap transposition simultaneously with OWT 20) and both reported favorable outcomes.…”