Vacuum-assisted closure in the paediatric patient with post-cardiotomy mediastinitis

Abstract

Mediastinitis has a high mortality and is a major cause for concern in the neonatal cardiac surgical population. Vacuum-Assisted Closure (V.A.C.) is a newly established technique for expediting healing in the management of wounds resistant to established treatments; this includes the treatment of post-cardiotomy mediastinitis in the adult cardiac surgical patient. We describe the previously unreported use of the V.A.C. device for the successful treatment of post-cardiotomy mediastinitis in an infant. The device also improved the mechanics of respiration. We discuss potential risks and benefits of V.A.C. and suggest guidelines for its use.

Vacuum-assisted closure for wound management in the pediatric population

“…Vacuum-assisted closure (VAC), initially described by Morykwas et al [1,2] in 1997, has been reported in the adult literature as a novel method of accelerating wound healing. However, few reports exist about children [3][4][5]. The VAC technique consists of insertion of an opencell foam sponge to the wound, sealing with an adhesive drape, and subsequent application of negative, subatmospheric pressure, usually at 125 mm Hg [2].…”

Use of vacuum-assisted closure system in the management of complex wounds in the neonate

“…The youngest patient in this series was 7 days old. VAC devices have been used to help manage complex soft tissue injuries in a 9-yearold victim of a dog bite [2] and in a pediatric patient who required complex mediastinal closure [6].…”

“…Vacuum-assisted closure (VAC, Kinetic Concepts, San Antonio, TX, USA) has been accepted since 1995 as an adjunct to the management of complex wounds in adults and children [1][2][3][4][5][6][7]. The negative-pressure wound therapy promotes the reduction of development of granulation tissue, thereby facilitating wound healing.…”

Sternal Wound Complications Following Cardiac Surgery

“…This promotes earlier and more effective patient mobilization and prevents the patient from being confined to bed, where other complications common to DSWI therapy are often incurred [70]. Negative pressure therapy also improves ventilation and overall pulmonary function and leads to more effective chest physiotherapy [70,97]. Importantly, no deleterious hemodynamic effects of NPT have been documented although this has been speculated [70].…”