Background: Vacuum-assisted closure (VAC) therapy has become a valuable tool in managing complex infections. However, its adaptation for intrathoracic use remains technically challenging due to risks of air leaks, cavity instability, and lack of standardized equipment for pulmonary applications.

Objective: To describe a novel VAC drainage system and pressure protocol specifically designed for pulmonary abscess management and evaluate its clinical feasibility in diabetic pa-tients.

Methods: An internally developed drainage system was constructed using a low-adhesion polyurethane sponge, modified thoracic catheter, and a programmable negative pres-sure regulator. The system delivers controlled suction at –80 mmHg, modulated through a pulsed cycle (5 minutes on, 2 minutes off). Clinical testing was performed in 12 patients with diabetic pulmonary abscess following surgical drainage. Parameters evaluated included tech-nical safety, drainage efficiency, cavity collapse rate, and postoperative complications.

Results: All patients tolerated the device well with no cases of bronchopleural fistula or sponge dislocation. Average drainage duration was 5.8 ± 1.0 days, and cavity volume reduction >75% was achieved in 83.3% of cases by day 7. No infections related to the device were ob-served. The pulsed suction mode allowed stable pressure delivery without over-collapse or hemothorax.

Conclusion: This customized VAC device and pressure protocol demonstrated clinical safety, technical stability, and high efficacy in managing pulmonary abscess in diabetic patients. It may serve as a prototype for broader use in thoracic VAC therapy and facilitate standardiza-tion in deep cavity infections.

Pulmonary abscess, negative pressure therapy, custom VAC device

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