Experience with Vacuum-Assisted Closure of Sternal Wound Infections Following Cardiac Surgery and Evaluation of Chronic Complications Associated with its Use (original) (raw)
Related papers
Vacuum-Assisted Closure in the Treatment of Sternal Wound Infection After Cardiac Surgery
Biomedical Papers, 2007
Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies. Methods: From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superfi cial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m 2 (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %). Results: Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to defi nite wound closure. Three patients (9 %) with chronic fi stula were re-admitted 1 to 6 months after VAC therapy. Conclusions: VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an eff ective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.
European Journal of Cardio-Thoracic Surgery, 2000
Infection of the sternotomy wound is a potentially devastating and sometimes lethal complication following cardiac surgery. Established treatment may involve a combination of debridement, packing, delayed closure, plastic reconstruction, re-wiring and irrigation dependent on the severity of infection. Vacuum assisted closure, originally adopted for the treatment of non-healing wounds, has recently gained popularity among various surgical specialities in managing complex wound infection. Here we describe this novel technique of managing postoperative sternal wound infection. q
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the micro...
Deep Sternal Wound Infection After Cardiac Surgery: Modality of Treatment and Outcome
The Annals of Thoracic Surgery, 2005
Background. Deep sternal wound infection is a serious and expensive complication after cardiac surgical procedures. We tried to identify risk factors for failure of vacuum-assisted sternal closure and compare the outcome and long-term quality of life (QoL) with the results obtained after sternal resection and muscle flap. Methods. Between January 1998 and December 2003, 5,690 patients underwent cardiac surgical procedures at our institution. Fifty-five patients who had deep sternal wound infection were identified between January 1998 and December 2003. In-hospital data were assessed and the outcome was analyzed. QoL, using the Short Form 36 Health Survey Questionnaire (SF-36), was assessed and an additional questionnaire focused on specific problems. Results. Overall mortality was 5.4%. Patients with successful vacuum-assisted sternal closure were younger and had fewer cumulative risk factors (chronic obstructive pulmonary disease, bilateral internal mammary artery , obesity, diabetes), than patients in whom secondary closure failed. Quality of life was better among patients with secondary vacuum-assisted closure than among patients with musculocutaneous flap. Independently of the modality of treatment, pain was not a serious problem reported by the patients during the follow-up. Conclusions. We conclude that preservation of the sternum should be the principal aim of surgical treatment in patients with deep sternal wound infection. Early diagnosis, aggressive surgical treatment by débridement, and the use of vacuum-assisted systems allows us to achieve a good long-term result with nearly normal QoL. Resection and musculocutaneous flap is a therapeutic option for high-risk patients, providing a safe, effective control of the infection, and it leads to acceptable results in terms of pain control and QoL.
2009
In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thickens skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds.
Vacuum-Assisted Closure for Sternal Wound Infection After Coronary Artery Bypass Surgery
Koşuyolu Heart Journal, 2021
Introduction: Vacuum-assisted closure of sternal infected wounds has been reported to improve morbidity and mortality, besides decreasing duration of hospitalization. The aim of this study was to evaluate early outcomes of vacuum-assisted closure of infected sternal wounds after coronary bypass surgery in our clinic. Patients and Methods: Sixty six patients who had sternal wound infection after coronary bypass surgery in our hospital between January 2016 and December 2019 were included in the study. After surgical debridement and removal of foreign materials, vacuum-assisted closure therapy was initiated at a mean postoperative 26.56 ± 5.5 days. After wound healing and negative cultures, treatment was terminated and sternal wounds were closed with appropriate procedures. Results: Fifty six patients (84.84%) had deep sternal infection and 10 patients (15.15%) had superficial sternal infection. Early mortality was 13.63% (nine patients), all having deep sternal infections. The most co...
CT10 MANAGING Deep Sternal Wound Infections with Vacuum Assisted Closure
ANZ Journal of Surgery, 2007
Purpose Deep sternal wound infection is a rare but serious complication of cardiac surgery. Currently there is no consensus on the optimal management. Vacuum Assisted Closure (V.A.C.) has been increasingly used to facilitate wound healing. We aim to review the management of deep sternal wound infections using V.A.C. dressing at our hospital.Methodology 31 consecutive deep sternal wound infections over a five year period were reviewed. V.A.C. dressing was used either as a stand alone therapy or as an intermediate therapy to late sternal reconstruction.Results Deep sternal wound infections were diagnosed on average 13 days from initial surgery. 26 (84%) patients were treated with V.A.C. dressing. Of these, 17 (65%) had stand alone V.A.C. therapy and 9 were followed by sternal reconstruction. The average duration of V.A.C dressing in the two groups were 21 and 13 days respectively. 7 patients died, 6 in the stand alone V.A.C. group and 1 in the intermediate V.A.C. group. The length ...
Jurnal Rekonstruksi dan Estetik, 2022
Background: Deep sternal wound infection (DSWI) or mediastinitis is a severe and life-threatening infection with high morbidity and mortality rates. Vacuum-assisted closure (VAC) provides good results and is very useful in wound closure. VAC therapy is a safe and affordable method for managing complex sternal and thoracic injuries. The use of VAC has been shown to increase parasternal blood flow by dilating arterioles, reducing bacterial load, and accelerating granulation tissue formation. It also helps with facilitating wound edge closure. Case and Operation Technique: A 6-month-old baby presented with an ulcer 2 cm deep in the thorax region. The wound had an exposed bone surrounded by slough and hyperemic edges. Bone destruction was seen to have reached the costochondral joint with a gross visible appearance of the pleura. Management of this patient included debridement, sternotomy, internal fixation of the sternum using the Robiscek technique, and application of the Water Shield Drainage (WSD) and VAC. The tobacco-sack technique was used to close the open wound. The Robiscek technique was used in this patient because of the bone destruction to the costochondral joints causing the sternum to become unstable. The VAC dressing was then connected to a suction with an intermittent negative pressure of 75mmHg. After a significant decrease in the wound surface area, a local rotational flap was used to close the wound. Conclusion: The use of modified VAC for deep sternal wound infection (DSWI) is effective, simple, and affordable with minimal complications.
Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence
Interactive CardioVascular and Thoracic Surgery, 2014
OBJECTIVES: Sternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments.