Vacuum Assisted Closure for the Treatment of Sternal Wounds: The Bridge between Débridement and Definitive Closure

Abstract

A method to refine the treatment of sternal wounds using Vacuum Assisted Closure (V.A.C.) therapy as the bridge between débridement and delayed definitive closure is described. A retrospective review of 35 consecutive patients with sternal wound complications over a 2-year period (March of 1999 to March of 2001) was performed. The treatment of sternal wounds with traditional twice-a-day dressing changes was compared with the treatment with the wound V.A.C. device. An analysis of the number of days between initial débridement and closure, number of dressing changes, number and types of flaps needed for reconstruction, and complications was performed. Eighteen patients were treated with traditional twice-a-day dressing changes and 17 patients were treated with V.A.C. therapy alone. The two groups were similar regarding age, sex, type of cardiac procedure, and type of sternal wound. The V.A.C. therapy group had a trend toward a shorter interval between débridement and closure, with a mean of 6.2 days, whereas the dressing change group had mean of 8.5 days. The V.A.C. therapy group had a significantly lower number of dressing changes, with a mean of three, whereas the twice-a-day dressing change group had a mean of 17 (p < 0.05). Reconstruction required an average of 1.5 soft-tissue flaps per patient treated with traditional dressing changes versus 0.9 soft-tissue flaps per patient for those treated with V.A.C. therapy (p < 0.05). Before closure, there was one death among patients undergoing dressing changes and three in the V.A.C. therapy group, all of which were unrelated to the management of the sternal wound. Patients with sternal wounds who have benefited from V.A.C. therapy alone have a significant decrease in the number of dressing changes and number of soft-tissue flaps needed for closure. Finally, the V.A.C. therapy group had a trend toward a decreased number of days between débridement and closure.

The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

“…The resulting high osmotic load destroys bacterial cells and authors have reported excellent rates of wound resolution associated with its use [34]. More recently, negative pressure dressings have been introduced and shown to be safe and effective in the management of sternal wounds [35][36][37]. However, although widely used, there are no randomised trials comparing the efficacy or costs of either of these therapies with the use of more conventional wound dressings.…”

Vacuum-assisted closure with a portable system for treatment of poststernotomy mediastinitis

“…Basic research suggests that the VAC suction pressure should be between 75 and 125 mmHg, [8][9][10] but the reservoir suction pressure of the J-VAC drainage system is around 55 mmHg. However, good results have been reported with a similar method, 7 and there were no particularly noteworthy problems in this case.…”

Mediastinitis

“…Mediyastenitlerin cerrahi tedavisinde açık ve kapalı olmak üzere iki farklı yaklaşım uygulanmaktadır. Açık yaklaşımda debridman ve drenaj sonrası mediyasten açık bırakılmakta, cerrahi pansuman ve intravenöz antibiyotik tedavisiyle beklenen iyileşme sağlandıktan sonra geç dönemde kapatılmaktadır (1,22). Bu yöntemin dezavantajları, toraksın mekanik desteğinin olmaması nedeniyle gelişen solunum yetmezliği, vasküler yapıların bütünlüğünün bozulması ve gecikmiş doku iyileşmesi olarak sıralanabilir (1).…”