Objectives Prolonged air leak is often associated with pain and immobilization and is a major limiting factor for discharge from the hospital. The efficacy of two surgical patches was investigated in the treatment of air leak following open surgery. Methods 45 patients were randomized in a 1:1 ratio either to treatment with Neoveil (polyglycolic acid) (n = 22) or TachoSil (collagen sponge) (n = 23). Air leak was monitored at 2, 4, 8, 12, 24 hours after surgery and then daily at 8 am and 6 pm, using a digital recording system. The primary outcome was the time to air leak closure. Secondary outcomes were incidence, air leak intensity, incidence of prolonged air leak, and incidence of pneumonia. Results Air leak 2 hours after surgery was observed in 11/22 (50%) versus 14/23 (61%) patients treated with polyglycolic acid, respectively with collagen sponge. On average, air loss within the first 24 hours after surgery was lower and declined faster in patients treated with polyglycolic acid. Time to pulmonary air leak closure was somewhat shorter with polyglycolic acid (median [interquartile range] 10 [2, 52] hours) compared to collagen sponge, (19 [2, 141] hours). However, the difference was not statistically significant (P = 0.35, Wilcoxon rank sum test). Prolonged air leak occurred in 3/22 (14%) versus 6/23 (26%) patients, and pneumonia occurred in 2/22 (9%) versus 3/23 (13%) patients treated with polyglycolic acid, respectively collagen sponge. Conclusions Both systems are effective in the treatment of air leak. Our results suggest a possible superiority of Neoveil over TachoSil in post-surgery air leak control. Clinical registration number NCT04065880

No abstract

Vacuum-assisted closure (VAC) therapy is a useful tool in the management of a wide spectrum of complex wounds in cardiothoracic surgery. It promotes healing through the application of a controlled and localized negative pressure on porous polyurethane absorbent foams. Known advantages of the VAC therapy are the acceleration of wound healing, stimulation of granulation tissue and reduced tissue edema. Despite its excellent properties, some related complications after and during the therapy have been reported. We report the case of a 47-year-old female with a thoracic wound infection after rib stabilization, managed with open surgery and VAC therapy, which was complicated by a diffuse lymphatic leakage. This is the first case described of diffuse lymphatic leakage followed by partial necrosis of the breast after continuous VAC therapy. We recommend the application of a lower pressure level of this device for complex wounds of the chest wall near the breast.

No abstract

No abstract