Vacuum-Assisted Closure for Sternal Wound Infection After Coronary Artery Bypass Surgery (original) (raw)

Experience with Vacuum-Assisted Closure of Sternal Wound Infections Following Cardiac Surgery and Evaluation of Chronic Complications Associated with its Use

Journal of Cardiac Surgery, 2008

Objectives: We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Methods: Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D)

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.

Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection

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

Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection

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...

Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery

European Journal of Cardio-Thoracic Surgery, 2003

Objective: To identify risk factors for sternal wound infection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome. Methods: Data were prospectively collected for 4228 patients who underwent CABG surgery between April 1997 and March 2001. One hundred and nine (2.6%) patients developed sternal wound infection. We used logistic regression to identify independent risk factors associated with post-operative sternal wound infection. Patient records were linked to the National Strategic Tracing Service, which records all deaths in the UK, to establish current vital status. Deaths occurring over time were described using Kaplan-Meier techniques. To control for differences in patient characteristics, we used Cox proportional hazards analysis to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: The results of the logistic regression analysis found that the independent predictors of sternal wound infection were obesity (odds ratio (OR) 2.0; P , 0:001), New York Heart Association class $ 3 (OR 1.6; P ¼ 0:022), use of bilateral internal mammary arteries (OR 3.2; P , 0:001), increasing number of grafts (OR 1.5; P , 0:001), re-exploration for bleeding (OR 3.1; P ¼ 0:011), and increased duration of mechanical ventilation (for every 10 h (OR 1.12; P , 0:001)). Three hundred and forty one (8.1%) deaths occurred during the study period with mean follow up of 3.2^1.3 years. The crude HR of mid-term mortality for sternal wound infection patients was 2.51 (95% CI 1.59-3.94, P , 0:001). After adjustment for pre, intra and post-operative factors, the adjusted HR of mid-term mortality for sternal wound infection patients was 1.64 (95% CI 1.03-2.61, P ¼ 0:037). The adjusted freedom from death for sternal wound infections at 30 days, and 1, 2 and 4 years was 96.8, 93.7, 91.4 and 86.7%, respectively, compared with 98.1, 96.1, 94.7 and 91.7% for patients without sternal wound infections. Conclusions: In conclusion, we have identified risk factors for sternal wound infection, many of which are modifiable. We have also shown that there is a significant increase in mortality in patients with sternal wound infection during a 4-year follow-up period after CABG.

Deep Sternal Wound Infection after Coronary Artery Bypass Surgery: Management and Risk Factor Analysis for Mortality

Heart Surgery Forum, 2014

Mediastinitis is a devastating sternal wound complication. The aim of this study was to identify the incidence, risk factors, mortality, and different treatment modalities of mediastinitis after isolated coronary artery bypass grafting. From January 2007 to May 2010, 1424 patients who underwent isolated coronary artery bypass grafting were studied retrospectively; 1398 (group 1) had no mediastinitis, and 26 (group 2) developed mediastinitis. The diagnosis and classification of mediastinitis were based on the criteria of the Center for Disease Control and Prevention and the Emory classification, respectively. Multivariate analysis showed only 4 risk factors: diabetes mellitus, obesity, prolonged postoperative intensive care unit stay, and prolonged intubation time. On univariate analysis, female sex, renal failure, and reexploration for bleeding were also significant risk factors. The incidence of mediastinitis (1.83%) and the subsequent mortality rate (7.69%) were comparable to those of previous reports. Early detection and aggressive management of mediastinitis play major roles in decreasing the related mortality and morbidity. The Emory classification with some modification is very helpful in choosing the proper treatment modality.

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 ...

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.