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 e mpyema thoracis following penetrating chest trauma. Methods: Over a 9- month period, eight patients at two institutions were treated for empy ema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound. All were treat ed 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 d eveloped 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 techniqu e. 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 wa s 110 minutes. There were two complications, a persistent air teak and a trapped lung, both treated with thoracoscopic intervention. Conclus ion: Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing aft er penetrating chest trauma.