Vol. 20 JA2016 - thoracic

T-11 – VAC Therapy with delayed chest wall closure: a rescue solution in case of intraoperative DIC

novembre 29, 2016
Auteur correspondant : Geoffrey Brioude

Geoffrey Brioude, Brice Caput, Joséphine Chenesseau, Delphine Trousse, Xavier-Benoît D’Journo, Christophe Doddoli, Pascal-Alexandre Thomas

Institution : Service de chirurgie thoracique et des maladies de l’œsophage, hôpital Nord, AP-HM, Marseille

Objectives : VAC therapy is actually used routinely in infected thoracic wound. We reported in this presentation an original use in thoracic surgery: VAC therapy to maintain sterile an unclose chest wall in lung transplant after massive bleeding managed with damage control surgery or after brutal lung oedema.

Methods : Lung transplant is an uncommun part in thoracic surgery, performed in specialized center. Surgeons are confronted to major bleeding due to patient’ background and the frequent use of ECMO in per-operating and post-operative. Furthermore lung tranplants are exposed to a major oedema included in the primary graft dysfunction. We decided to report an originally case series of management of catastrophic bleeding and lung oedema in lung transplantation.

Results : Between January 2014 and august 2016, 100 bilateral lung transplant were performed in our unit. 19 patients were re-operated. Fourteen of them for postoperative hemothorax or bleeding, 4 for anastomotic leakage and 1 for a delayed chest wall closure. We identified 7 patients requiring a pleural packing or VAC therapy following surgery. Four of them had pleural packing for bleeding at the end of lung transplant more or less associated to VAC therapy. Two patients had a delayed strategy (day 2 or 3) for pleural packing. One patient had only a VAC therapy due to a major lung oedema. Five patients were weaned of the circulatory support and had a chest was closure in a period between day 5 and day 15. Two patients died of an uncontrolled bleeding. A mean of 3.4 intervention were realized onbed in ICU or in the OR.

Conclusion : Pleural packing and delayed chest wall closure used in a spirit of damage control surgery is an efficient option in case of uncontrolled bleeding associed with lung oedema after lung transplantation