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

Abstract

When pleural empyema is treated with open-window thoracostomy, only 35% of cases are successfully closed, requiring an average of 4.5 months of treatment until wound closure. Conventional treatments such as daily gauze replacement often result in insufficient re-expansion of the collapsed lung, and surgical procedures such as thoracoplasty, muscle flap transposition, and omentoplasty are often necessary. We report a case of acute pleural empyema secondary to coronavirus disease 2019 treated with negative-pressure wound therapy (NPWT). After a month of conservative treatment following open-window thoracostomy, NPWT was performed for three weeks, and the thoracostoma was completely closed with the expanded lung. Approximately one week later, epithelialization of the exposed pleura was completed, and the patient was discharged. Six months after healing, there was no recurrence of pleural empyema. In this case, NPWT resulted in good pulmonary expansion and likely shortened the healing time. Although NPWT is contraindicated in wounds with exposed organs, the use of a contact layer and appropriate negative-pressure settings ensured safe treatment in our patient. We report the results of this study, along with a review of the available literature.