Vacuum-assisted closure for chest wall reconstruction infection caused by Streptococcus mitis after surgery of lung cancer: a case report

TL;DR

A 64-year-old lung cancer patient with a chest wall infection was successfully treated with vacuum-assisted closure without removing the artificial prosthesis.

Contribution

This case report demonstrates the successful use of vacuum-assisted closure to treat a chest wall infection without prosthesis removal.

Findings

Vacuum-assisted closure (VAC) therapy successfully treated a chest wall infection around a PTFE sheet without requiring prosthesis removal.

The patient's wound granulation progressed and wound closure was achieved 6 weeks after starting VAC therapy.

The case highlights the potential of VAC therapy as an alternative to prosthesis removal in chest wall reconstruction infections.

Abstract

Among a cohort of patients who underwent chest wall resection and reconstruction by rigid prosthesis, 6% required removal of the prosthesis, and in 80% of these cases the indication for prosthesis removal was infection. Although artificial prosthesis removal is the primary approach in such cases of infection, the usefulness of vacuum-assisted closure (VAC) has also been reported.

A 64-year-old man with diabetes mellitus underwent right middle and lower lobectomy with chest wall (3rd to 5th rib) resection and lymph node dissection because of lung squamous cell carcinoma. The chest wall defect was reconstructed by an expanded polytetrafluoroethylene (PTFE) sheet. Three months after surgery, the patient developed an abscess in the chest wall around the PTFE sheet. We performed debridement and switched to VAC therapy 2 weeks after starting continuous drainage of the abscess in the chest wall. The space around the PTFE sheet gradually decreased, and formation of wound granulation progressed. We performed wound closure 6 weeks after starting VAC therapy, and the patient was discharged 67 days after hospitalization.

We experienced a case of chest wall reconstruction infection after surgery for non-small cell lung cancer that was successfully treated by VAC therapy without removal of the prosthesis. Although removal of an infectious artificial prosthesis can be avoided by application of VAC therapy, perioperative management to prevent surgical site infection is considered essential.

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