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Thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest injury.

PURPOSE
The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma.


METHODS
Over a 9-month period, eight patients at two institutions were treated for empyema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound. All were treated for hemothorax with a closed tube thoracostomy. Associated injuries included six spinal cord injuries, a liver and diaphragmatic injury, a subclavian injury, and a carotid injury. Each patient subsequently developed an empyema. All patients underwent one thoracoscopic drainage and decortication of the empyema.


RESULTS
In all patients, complete resolution of the empyema was achieved with the thoracoscopic technique. Chest tubes were removed a median of 8.5 days after the procedure. Median blood loss was 200 mL. The average duration of the operation was 110 minutes. There were two complications, a persistent air leak and a trapped lung, both treated with thoracoscopic intervention.


CONCLUSION
Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing after penetrating chest trauma.