• Empyema
• Surgical Tecnique
• Thoracic Surgery
• Thoracostomy

OWT is a relatively rare surgical intervention in contemporary practice, predominantly reserved for managing chronic pleural infections or complications associated with thoracic surgery, such as post-operative empyema or persistent pleural sepsis.
The primary objective of this thesis is to present a detailed analysis of a decade-long experience of a highly specialized French cardiovascular and thoracic surgical center (Hôpital Marie Lannelongue, Le Plessis Robinson) with OWT procedure, spanning the period from March 2014 to 2024.
Given the rarity and complexity of this procedure, our aim is to thoroughly examine several key aspects. The study will explore the specific clinical indications that have justified the use of OWT during the past decade, with a particular focus on the underlying pathological conditions, patient comorbidities, and the clinical decision-making processes leading to its adoption.
An important aspect of the study will involve analyzing the surgical techniques employed during the initial open window thoracostomy procedure. This includes exploring the variations in surgical approaches, based on the extent of disease, anatomical considerations, and surgeon preference. Furthermore, the study will assess the different strategies used to manage the residual cavity over time, including delayed closure or maintenance of the open window.
Another critical focus will be the methods used for the closure of the thoracic cavity once infection control has been achieved. The thesis will document and analyze the various closure techniques, including muscle flap transposition, vacuum-assisted closure (VAC) therapy, and other advanced wound care techniques. This section will also highlight the timing of the closure, the criteria for determining readiness for closure, and the outcomes associated with different closure methods. The choice of the flap is made in relation to the volume of the thoracic cavity, location, and previous operation (type of thoracotomy, history of previous abdominal surgery), and status of thoracic infection. The outcomes of the closure techniques will primarily be assessed in terms of local infection control. Given the complexity of the patient population in this study, which includes individuals who have undergone lung transplants or are oncological patients, a broader discussion of mortality is challenging. These patients represent a highly complex and unique cohort, making it more appropriate to focus on local control and the need for reintervention. This focus on local management reflects the particular challenges presented by this patient population and ensures a more precise evaluation of the procedural outcomes.
The long-term outcomes of patients who have undergone OWT will be carefully evaluated. This includes assessing morbidity and mortality rates, the success of infection resolution, respiratory function outcomes, and overall patient quality of life post-procedure. Complications, both intraoperative and postoperative, will be closely examined, with an emphasis on recurrent infections, prolonged hospital stays, and the need for further interventions
The technical challenges faced during both the initial OWT procedure, and the closure of the residual cavity will be analyzed in depth. Particular attention will be paid to the specific difficulties encountered when managing patients with complex thoracic anatomy, large pleural spaces, or compromised pulmonary function. Additionally, the study will address the broader challenges related to the clinical condition of the patient, who is often critically ill, immunocompromised, or suffering from multi-organ failure, complicating both the surgery and recovery processes.
Lastly, the thesis will consider future directions for the use of open window thoracostomy, examining emerging trends in surgical techniques, potential technological advancements, and the evolving role of minimally invasive approaches in the management of pleural infections and empyema. This section will also explore the possibility of new protocols for patient selection, perioperative management, and postoperative care to optimize outcomes. Through this analysis, the thesis aims to provide valuable insights into the decision-making processes, surgical approaches, and outcomes associated with open window thoracostomy, contributing to the limited body of literature on this challenging and rare procedure. The results of this study could inform clinical guidelines, improve patient selection, and refine surgical techniques, ultimately enhancing patient care in the field of cardiothoracic surgery.