Foam Sponge Research Articles

Pull-through endoscopic vacuum-assisted closure therapy for complicated leaks of the gastrointestinal tract – a novel technique

Background and study aims Endoscopic vacuum-assisted closure (EVAC) of post-surgical leaks is an increasingly applied technique. Precise intracavitary sponge placement is technically challenging. Here, we describe a novel EVAC therapy using a combined external and endoluminal, pull-through technique. Patients and methods In this retrospective cohort study, we included all patients treated with pull-through EVAC for post-surgery leaks. During endoscopy, the proximal tip of the percutaneous drainage was visualized within the extraluminal abscess cavity, grasped with forceps, and pulled out orally while maintaining the distal end of the drainage above skin level. A foam sponge was fixed to the tip of the percutaneous drainage and sutured to a gastric tube at the other end. The sponge was placed in the cavity by pulling at the percutaneous drainage. Finally, the gastric probe was channeled nasally and suction was applied. Re-interventions comprised pulling the gastric tube, exchanging the sponge, and re-positioning, as described above. Therapy was stopped after closure or complete epithelialization of the leakage. Results Overall, 7 patients were included between 2021 and 2023. Median duration of pull-through EVAC therapy was 30 days (IQR 11 – 37 days) and median number of endoscopic interventions was 6 (IQR 4 – 10). Technical and clinical success was achieved in all (100%) and in 6 of 7 patients (85.7%), respectively. In total, one major bleeding complication associated with EVAC therapy occurred (14.3%). Conclusion Pull-through EVAC therapy is safe and effective in patients with large and challenging post-surgical leaks of the upper GI tract.

Environmental Fungal Contamination Characterization of Three Inpatient Units Utilizing Optimized Detection Methods

Background: Environmental sampling and detection methods for fungi in healthcare settings are not well-established. We previously refined methods for fungal sampling and detection in a controlled laboratory environment and aimed to validate them in a real-world healthcare setting. Methods: We performed a microbiological analysis of air and surfaces in three inpatient units at a tertiary care center. Surface samples were obtained with foam sponges from 3 locations in patient rooms (Patient bedrails, bathroom floor, HVAC export) and 5 locations in units (HVAC exports 3x, clean linen storage, soiled linen storage). Air samples were taken with an active air sampler directly below HVAC exports. Sponges were processed using the stomacher technique. Samples underwent DNA extraction followed by qPCR with FungiQuant primers targeting the 18S rRNA gene. Amplicons from positive samples were sequenced (NextSeq 1000, 300bp PE) and SmartGene databases were used to interpret sequence data. For comparison to culture methods, samples were also plated onto Sabouraud and HardyCHROM Candida + auris medias. Fungal growth underwent DNA extraction, 18S PCR and Sanger sequencing for genus and species identification. Results: A total of 85 samples were obtained, from 15 patient rooms and three units resulting in 61 surface and 24 air samples. Patients in study rooms had a median age of 53, 9 (60%) were male, and no patients had an invasive fungal infection during their hospital encounter. 44 (53%) and 39 (46%) samples were positive for fungi via qPCR and culture, respectively. Of the 44 positive qPCR samples, microbiome analyses identified at least one fungi to the species, genus and family levels in 43 (98%), 28 (64%), 18 (41%) samples, respectively (Table 1). 114 total isolates were identified of which the most common were Mallassezia restricta (30 [26%]), Malassezia globose (29 [25%]), and Pennicillium paradoxum (4 [4%]). 39 genera were identified of which the most common were Mucor (19 [49%]) and Candida (8 [21%]). Of the 39 culture positive samples, 90 total isolates were recovered. The most common species were Paradendryphiella arenariae (19 [21%]), Aspergillus niger (12 [13%]) and Penicillium commune (12 [13%]). Conclusion: These results demonstrate the presence of diverse fungal species in both air and surface samples across inpatient units. Higher sensitivity was noted utilizing qPCR, however, identified genera and species were markedly different between qPCR and culture methods. Larger studies are needed to assess the efficacy of qPCR for fungal detection in the healthcare environment.

Advanced Applications of Porous Materials in Triboelectric Nanogenerator Self-Powered Sensors.

Porous materials possess advantages such as rich pore structures, a large surface area, low relative density, high specific strength, and good breathability. They have broad prospects in the development of a high-performance Triboelectric Nanogenerator (TENG) and self-powered sensing fields. This paper elaborates on the structural forms and construction methods of porous materials in existing TENG, including aerogels, foam sponges, electrospinning, 3D printing, and fabric structures. The research progress of porous materials in improving TENG performance is systematically summarized, with a focus on discussing design strategies of porous structures to enhance the TENG mechanical performance, frictional electrical performance, and environmental tolerance. The current applications of porous-material-based TENG in self-powered sensing such as pressure sensing, health monitoring, and human-machine interactions are introduced, and future development directions and challenges are discussed.

Comparative analysis of sampling and detection methods for fungal contamination on common healthcare environment surface materials.

We evaluated sampling and detection methods for fungal contamination on healthcare surface materials, comparing the efficacy of foam sponges, flocked swabs, and Replicate Organism Detection And Counting (RODAC) plates alongside culture-based quantification and quantitative polymerase chain reaction (qPCR). Findings indicate that sponge sampling and qPCR detection performed best, suggesting a foundation for future studies aiming to surveillance practices for fungi.

Unraveling Paradoxical Effects of Large Current Density on Zn Deposition.

Aqueous zinc-based batteries (ZBs) have been widely investigated owing to their intrinsic safety, low cost, and simple assembly. However, the actual behavior of Zn deposition under large current density is still a severe issue associated with obscure mechanism interpretation of ZBs under high loading. Here, differing from the conventional understanding that short circuit is induced by dendrite penetrating under large current density (10-100mA cm-2), the separator permeation effect is unraveled to illustrate the paradox between smooth deposition and short lifespan. Generally, a dense plating morphology is achieved under large current density because of intensive nuclei and boosted plane growth. Nevertheless, in the scenes applying separators, the multiplied local current density derived from narrow separator channels leads to rapid Zn2+ exhaustion, converting the Zn deposition mode from nucleation control to concentration control, which eventually results in separator permeation and short circuit. This effect is validated in other aqueous metal anodes (Cu, Sn, Fe) and receives similar results. Based on the understanding, a micro-pore (150µm) sponge foam is proposed as separators for large-current anodes to provide broader Zn2+ path and mitigate the separator permeation effect. This work provides unique perspectives on coordinating fast-charging ability and anode stability of ZBs.

Precise healing of oral and maxillofacial wounds: tissue engineering strategies and their associated mechanisms.

Precise healing of wounds in the oral and maxillofacial regions is usually achieved by targeting the entire healing process. The rich blood circulation in the oral and maxillofacial regions promotes the rapid healing of wounds through the action of various growth factors. Correspondingly, their tissue engineering can aid in preventing wound infections, accelerate angiogenesis, and enhance the proliferation and migration of tissue cells during wound healing. Recent years, have witnessed an increase in the number of researchers focusing on tissue engineering, particularly for precise wound healing. In this context, hydrogels, which possess a soft viscoelastic nature and demonstrate exceptional biocompatibility and biodegradability, have emerged as the current research hotspot. Additionally, nanofibers, films, and foam sponges have been explored as some of the most viable materials for wound healing, with noted advantages and drawbacks. Accordingly, future research is highly likely to explore the application of these materials harboring enhanced mechanical properties, reduced susceptibility to external mechanical disturbances, and commendable water absorption and non-expansion attributes, for superior wound healing.

Increasing risk of invasions by organisms on marine debris in the Southeast coast of India

Increasing amount of anthropogenic litter in the marine environment has provided an enormous number of substrates for a wide range of marine organisms, thus serving as a potential vector for the transport of fouling organisms. Here, we examined the fouling organisms on different types of stranded litter (plastic, glass, rubber, foam sponge, cloth, metal and wood) on eight beaches along the southeast coast of India. In total, 17 encrusting species belonging to seven phyla (Arthropoda, Bryozoa, Mollusca, Annelida, Cnidaria, Chlorophyta and Foraminifera) were identified on 367 items, with one invasive species, the mussel Mytella strigata, detected. The most common species associated with marine litter were the cosmopolitan bryozoans Jellyella tuberculata (%O = 31.64 %) and J. eburnea (28.61 %), the barnacle species Lepas anserifera (29.97 %), Amphibalanus amphitrite (22.34 %) and Amphibalanus sp. (14.16 %), and the oyster species Saccostrea cucullata (13.62 %) and Magallana bilineata (5.44 %). We also reported the first records on stranded litter of four species: the gastropod species Pirenella cingulata and Umbonium vestiarium, the foraminiferan Ammonia beccarii, and the oyster M. bilineata. This study is thus the first documentation of marine litter as a vector for species dispersal in India, where the production and consumption of plastic rank among the highest in the world. We also highlight the increasing risk of invasions by non-indigenous organisms attached to debris along the southeast coast of India. Comprehensive monitoring efforts are thus needed to elucidate the type of vectors responsible for the arrival of invasive species in this region. Raising awareness and promoting education are vital components in fostering sustainable solutions to combat plastic pollution in the country and globally.

DESIGN OF A COMPUTER MOUSE FOR PEOPLE WITH SPECIAL NEEDS (DISABLED OR CUT OFF HANDS)

Industrial design takes it upon itself to innovate and develop products that contribute to providing appropriate solutions that can interfere with human uses in the various aspects of his life. To practice some activities like their healthy-bodied peers، including the computer, whether portable or desktop, and from which the need emerged to find appropriate solutions to these problems and obstacles for the disabled person to practice his work efficiently and comfortably. Therefore، the research problem emerged in how to find the appropriate solution according to the foundations and rules of design through a design in which those obstacles that confront a group of people who suffer as a result of their physical condition are addressed computer for that of class The importance of the design included several aspects، whether at the level of the external appearance or at the level of functional performance and increasing the effectiveness of the design through form and function. Also، the electronic materials and parts used in the production of the mouse are from the available materials, as it relies on the foam sponge material in the area for the support of the foot, and it also included the electronic parts of the control panel associated with each of its functional parts.

High-sensitivity RGO-TiO2 humidity sensor driven by triboelectric nanogenerators for non-contact monitoring of human respiration

Respiratory monitoring is an effective method to assess human health and provides valuable information for early warning and diagnosis of respiratory diseases. However, respiratory monitoring equipment relies on traditional power supply model, which limits real-time monitoring of breathing in fields of outdoor adventure, nomadism and long-distance running. As a solution, a triboelectric nanogenerator (TENG)-driven self-powered humidity sensor for human breath monitoring was prepared. A flexible TENG composed of Ti3C2Tx: PDMS composite film and Ni/Cu polyurethane foam sponge was used as self-powered part of the device, RGO-TiO2 humidity sensor was used as the respiratory sensing part of the device. Compared with the traditional humidity sensor, TENG-driven self-powered RGO-TiO2 (TENG-RGTO) shows high response (359.2), fast response/recovery time (1/5.2 s), good reversibility, small humidity hysteresis (0.54%) in the range from 0% RH to 95% RH. Furthermore, TENG-RGTO humidity sensor can realize recognition of breathing states at different frequencies and intensities in real time. Meanwhile, a breathing alarm device driven by humans is designed. This research not only broadens the application range of TENG but also provides a new design idea for self-powered breathing monitoring sensor.

Descriptive Study of Contact Dermatitis to Sponge Production Workers in Esterindo Factory

Contact dermatitis is a major health problem of skin disease for workers who have a history contact with chemicals or irritants. This disease can usually be found in industry, plantations or agriculture. In 2020, from 27,000 workers resulted prevalence rate of dermatitis was around 9.8%. The aim of this study is to describe the incidence of contact dermatitis in sponge foam production workers at Esterindo factory on the last week of August until the first week of September, 2021. This research is a descriptive study with a method of cross-sectional study. TBased on the results, workers with contact dermatitis were 14 workers, 18,4%. The most common groups who got contact dermatitis were the age group of 40-49 years (31,8%), women (15,7%), pasting sponge group (33,3%), average working period in 2 years and a half month, in average 5 days of working and an average of 7 hours working in a day. The total workers who has contact dermatitis in Esterindo factory are 14 workers (18,4%). The incidence of contact dermatitis in Esterindo factory could be affected from discipline of workers in the use of personal protective equipment, characteristics of activities in each worker, medical history and history of skin diseases.

Flame-resistant bifunctional MOF-based sponges for effective separation of oil/water mixtures and enzyme-like degradation of organic pollutants

Water pollutions that come from spilled oils, discharged organic reagents and abused pesticides have become an urgent problem to ecosystem. In this study, inspired by the multi-properties of MOF materials, we presented a bifunctional MOF-based sponge (OPA-UiO-66 @MF) to achieve the effective oil/water separation as well as the catalytic degradation of organic pollutants. On one hand, upon the in-situ growth of UiO-66 on melamine foam (MF) sponges and the octadecyl-phosphonic acid (OPA) modification of UiO-66, we highlighted the superhydrophobic/superoleophilic property of the OPA-UiO-66 @MF, which leads to excellent performances in oils adsorption and continuous oil/water separation. On the other hand, benefits from the lipase-like property of UiO-66, OPA-UiO-66 @MF was proved having potential ability in the catalytic degradation of carboxylic acid ester pesticides which are usually enriched in oils or organic solvents. Moreover, since phosphorus containing groups can be introduced onto the surface of sponge through OPA modification, OPA-UiO-66 @MF also displayed superior flame resistance. As an effective, safe and green material, the developed flame-resistant bifunctional OPA-UiO-66 @MF sponge might provide a promising application in the elimination of organic pollutants in water systems.

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery.

OBJECTIVESTo evaluate the feasibility of open chest management with our modified negative pressure wound therapy immediately after cardiac surgery as a therapy for atypical tamponade.METHODSOpen chest with modified negative pressure wound therapy was performed immediately after cardiac surgery. The surface of the heart and the vessels were covered with non-adherent siliconized gauze. The sternal halves were stented using edge-cut disposable syringes to maintain a larger mediastinal cavity. Approximately 45 mm of distance was kept between the sternal edges. A trimmed sterile polyvinyl foam sponge was inserted into the mediastinum, the entire wound was sealed and negative pressure (−50 to −75 mmHg) was applied using a suction generator. Delayed chest closure was performed in a standard manner once the haemodynamic status was stabilizsed.RESULTSThe mortality rate was 3/15 (20%) patients. Deep sternal wound infection occurred in 1/15 (6.7%) patients. Five patients were extubated during the open chest management. Sternal closure was delayed for median of 3 days after the initial surgery. There was no incidence of bleeding complications or need for additional haemostatic procedures.CONCLUSIONSNegative pressure wound therapy performed immediately after cardiac surgery was feasible in our small number of patients.Clinical registration numberStudy ID: 2020-149.

Management of post-operative pancreatic fistulas following Longmire\u2013Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

BackgroundPylorus-preserving pancreatoduodenectomy (PPPD) with pancreatogastrostomy is a standard surgical procedure for pancreatic head tumors, duodenal tumors and distal cholangiocarcinomas. Post-operative pancreatic fistulas (POPF) are a major complication causing relevant morbidity and mortality. Endoscopic vacuum therapy (EVT) has become a widely used method for the treatment of intestinal perforations and leakages. Here we report on a pilot single center series of 8 POPF cases specifically caused by dehiscences of the pancreatogastric anastomosis (PGD), successfully managed by EVT.MethodsWe included all patients with PGD after PPPD, who were treated with EVT between 07/2017 and 08/2020. For EVT a vacuum drainage film (EVT film) or open-pore polyurethane foam sponge (EVT sponge) was fixed to a 14Fr or 16Fr suction catheter and placed endoscopically within the PGD for intracavitary EVT with continuous suction between − 100 and − 150 mmHg. The EVT film/sponge was exchanged twice per week. EVT was discontinued when the PGD was sufficiently healed.ResultsPGD closure was achieved in 7 of 8 patients after a mean EVT time of 16 days (range 8–38) and 3 EVT film/sponge exchanges (range 1–9). One patient died on day 18 after PPPD from acute hemorrhagic shock, unlikely related to EVT, before effectiveness of EVT could be fully achieved. There were no adverse events directly attributable to EVT.ConclusionsEVT could be an effective and safe addition to our therapeutic armamentarium in the management of POPF with PGD. Unless prospective comparative studies are available, EVT as minimally invasive therapeutic alternative should be considered individually by an interdisciplinary team involving endoscopists, surgeons and radiologists.

529 Safeguarding Skin Grafts: A 21st Century Algorithm for Fixation Techniques

Abstract Aim Effective skin graft fixation is fundamental in preventing sheering forces, seroma and haematoma from compromising graft take. However, determining the ideal method of graft fixation remains a contentious subject. Currently, there is significant variation in fixation techniques used, based not only on clinical requirement, but also surgeon preference. Evidence-based recommendations are necessary to guide the decision-making process. Method We undertook a PRISMA-based assessment of the literature to define all fixation techniques and analyse their outcomes. Inclusion and exclusion criteria were composed. A search of Medline and Embase was performed, yielding 399 articles. After abstract screening, 96 were included for qualitative data analysis. Results Nine fixation techniques were identified: ‘tie over bolster’, ‘staple fixation’, ‘simple dressings’, ‘quilting sutures’, ‘re-look methods’, ‘foam sponge bolster’, ‘adhesive glues’, ‘negative pressure wound therapy’ and ‘less common techniques. We analyse the available evidence for each technique, identifying 13 studies with level I/II evidence. We summarise the research that underpins these nine categories, proposing an algorithm to facilitate technique selection based on anatomical and patient-specific factors. Conclusions An array of skin graft fixation techniques are used in plastic surgery, without clear guidelines. To our knowledge, this is the first time all fixation techniques have been defined. Our suggested algorithm is intended to aid surgeons in selecting an appropriate fixation technique and should be challenged by future research, particularly randomised control trials.

Percutaneous transhepatic biliary puncture simulator: a cord network prototype

BackgroundThe aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures.MethodsAn anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model.ResultsAfter receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session.ConclusionsThis proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver.Trial registrationRetrospectively registered

Substrate-Independent Ti3C2Tx MXene Waterborne Paint for Terahertz Absorption and Shielding.

With the development of terahertz (THz) technology, there is a booming demand of THz shielding/absorption materials to avoid electromagnetic interference (EMI) or pollution. Paints that can be fast solidified to form a film and stably adherent on arbitrary substrates are especially desired for the shielding/absorption applications. Recently, MXenes with high electron conductivity and hydrophilicity have attracted a great interest for EMI shielding. Here, we demonstrate a copolymer-polyacrylic latex (PAL) based MXene waterborne paint (MWP), which not only has strong THz EMI shielding/absorption efficiency but also can easily adhere onto various substrates that are commonly used in the THz band. The viscosity of MWP can be tuned by adjusting the colloidal and viscous forces, and the cyano group in PAL provides a strong intermolecular polar interaction between MWP and the substrate. As a result, a 38.3-μm-thick MWP on quartz exhibits EMI shielding value of 64.9 dB, and an excellent reflection-loss of 32.8 dB is obtained on MWP coated sponge foam. This substrate-independent MWP provides a simple and efficient way to achieving high-performance THz shielding/absorption.

Successful rehabilitation of an oiled sea turtle (Lepidochelys olivacea) affected by the biggest oil spill disaster in Brazil

The standardisation of protocols and discussion of therapeutic procedures in the rehabilitation of turtles affected by oil spills are necessary to optimise the recovery time and increase the chances of survival of these animals. This study aimed at reporting the processes adopted for the stabilisation, decontamination, rehabilitation and release of an oiled olive ridley sea turtle (Lepidochelys olivacea), rescued alive on September 23, 2019, at Santa Rita Beach, Extremoz municipality, Rio Grande do Norte, Brazil. Its entire body was covered by oil. At first, the animal was mechanically dry cleaned using a gauze soaked in mineral oil in the keratinised regions (carapace and plastron) and a gauze soaked in vegetable oil was used on the oral, nasal, ocular, and cloacal mucous membranes. The second stage of the oil removal consisted of washing the animal with heated pressurised water (39 °C) and a neutral detergent using a soft foam sponge. The animal received treatment with antitoxins, antibiotics, analgesics, gastrointestinal protectors, and fluid therapy. After 7 days of treatment, the blood count showed that all the parameters were within the normal range. The oil cleaning process and the therapeutic protocol used in the rehabilitation of the olive ridley sea turtle were efficient.

Polysaccharides-modified chitosan as improved and rapid hemostasis foam sponges

Serial hemostatic sponges consisting of polysaccharides-modified chitosan foam sponges were prepared by Schiff base crosslinking reaction between the deacetylated chitosan and oxidized dialdehyde cellulose. Such composite foam sponges were characterized by scanning electron microscopy and Fourier-transform infrared spectroscopy to confirm their morphology and compositions. Then the coagulation process was evaluated in vitro by thrombus elasticity meters. Furthermore, the hemostasis experiments on mouse tail vein and rabbit femoral artery were also performed in vivo. The results strongly indicated that such synergistic cellulose-modified chitosan foam sponges showed comprehensively excellent water-absorbing quality, improved mechanical performance, low hemolysis rates, benign cytotoxicity, good resilience ability after repeated compression, and superior hemostasis capability both in vitro and in vivo. Furthermore, the hemostatic mechanism is via adhering/activating the red blood cell/platelet to form robust blood clots through the endogenous coagulation pathway, which serves as a good candidate for emergency trauma treatment in daily civilian and military hemostasis.

Start-up of a trickling photobioreactor for the treatment of domestic wastewater.

A stand-alone trickling photobioreactor (TPBR) was seeded with activated sludge and microalgae to treat domestic wastewater. The TPBR was started-up at 12-h hydraulic retention time at room temperature with 12:12h light:dark cycle. The light was provided by blue LED strips. The reactor has a total volume of 30L and is divided into six segments. Each segment is 30cm long and has a diameter of 15cm. Each segment was packed with polyurethane foam sponge cubes (2.5×2.5×2.5cm3 ) with 40% occupancy. The chemical oxygen demand (COD), total organic carbon (TOC), total nitrogen (TN), and phosphorus (P) of domestic wastewater varied in the range of 164-256mg/L, 84.4-133.8mg/L, 34.2-55.6mg/L, and 24.7-39.3mg/L,respectively, during this period. The COD, TOC, TN, and P concentrations in the effluent after 45days of operation were 30.24±3.36mg/L, 7.69±0.09mg/L, 16.67±0.39mg/L, and 17.48±0.5mg/L, respectively. The chlorophyll-to-biofilm biomass ratio increased during the experimental period. The above results indicate that the algal-bacterial symbiotic relationship is beneficial for carbon and nutrient removal from domestic wastewater. PRACTITIONER POINTS: Trickling photobioreactor works on natural ventilation and has low power requirements and a small footprint. The porous sponge media helped in immobilizing and subsequent harvesting of biomass. The reactor conditions favored the growth of diatoms (brown algae) over green algae.

Bilateral Lobar Lung Transplantation after Smoke Inhalation Injury - A Case Report

Introduction Pulmonary fibrosis due to smoke inhalation injury has to our best knowledge previously not been reported as an indication for lung transplantation (LTx). For small adult and pediatric recipients, lobar LTx can be an option to solve the issue with size mismatch with donors. Case Report A 41-year old woman developed pulmonary fibrosis due to smoke inhalation injury after a suicide attempt in 2013. After long term careful psychiatric evaluation, the patient was listed for LTx in 2017. Due to her short stature of 145 centimetres and underweight (BMI 16), finding matching organs was difficult. Her condition slowly deteriorated and early 2020, veno-arterial extracorporeal membrane oxygenation (vaECMO) was initiated. After eight days on vaECMO she was lung transplanted with bilateral lower lobes. By then she was severly underweight (BMI 14). The postoperative period was complicated with haemorrhage and severe respiratory failure. The patient developed multiple organ failure and an iatrogenic esophageal perforation was discovered. It initially measured 2 × 1 centimetres, increased to a maximum of 7 × 1 centimetres and was treated with endoluminal vacuum therapy (VAC). The foam sponge was replaced every three days, and after 2 months only a fibrin-coated surface remained and VAC was discontinued. Weaning from mechanical ventilation was not possible until after 4 months, which in part was caused by the treatment of the perforation. The patient was discharged with nutritional and respiratory support after 6 months in hospital. At a follow up visit 2 months later she was in good health, mentally stable and required neither non-invasive ventilation nor percutaneous endoscopic gastrostomy for nutrition. Summary This case report highlights a rare - if not unique - etiology of chronic respiratory failure leading to lung transplantation. Iatrogenic esophageal perforation occurred post LTx, previously always requiring major surgery, now treated successfully with VAC. Despite challenges both pre and post transplantation, the outcome was eventually successful.